Out‐of‐hospital extracorporeal membrane oxygenation cannulation for refractory ventricular fibrillation: A case report

Out‐of‐hospital cardiac arrest survival continues to be dismal with the only recent improvement being that of extracorporeal cardiopulmonary resuscitation (E‐CPR) or cardiopulmonary resuscitation (CPR), augmented by extracorporeal membrane oxygenation (ECMO). Minimizing time until initiation of E‐CPR is critical to improve neurologically intact survival. Bringing E‐CPR to the patient rather than requiring transport to the emergency department may increase the number of patients eligible for E‐CPR and the chances for a good outcome. We developed a out‐of‐hospital E‐CPR (P‐ECMO) program that includes the novel use of a hand‐crank and emergency medical services (EMS) providers as first assistants. Here, we report the first P‐ECMO procedure in North America for refractory ventricular fibrillation involving a 65‐year‐old male patient who was cannulated in the field within the recommended 60‐minute low‐flow window and transported to our institution where he underwent coronary stenting. Details of program design and the procedure used may allow other systems to consider implementation of a P‐ECMO program.