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Войти в исследования Resuscitation · 2026
The FaciLItated hospital-based ECPR via Helicopter Transport (FLIGHT-to-ECPR) study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Gottula Adam L, Wilcox Alexander, Sipprell Kevin, Sebastian Pierre, Rixmann Kevin, Rees Paul, Kalra Rajat, Bruen Charles, Weiner Josh, Tanghe Peter, Peterson Bjorn, Howell Josh, Harkins Kim, Bartos Jason, Yannopoulos Demetris
Аннотация
INTRODUCTION: Survival after out-of-hospital cardiac arrest (OHCA) remains poor, particularly for refractory ventricular fibrillation/ventricular tachycardia (VF/VT). Extracorporeal cardiopulmonary resuscitation (ECPR) improves outcomes when delivered within 60 min of low-flow time, although geographic constraints frequently extend this interval in rural settings.
RESEARCH QUESTION/HYPOTHESIS: We hypothesized that a Helicopter-EMS (HEMS)-facilitated, hospital-based ECPR pathway could expand rural access while preserving clinical outcomes comparable to standard ground-transport ECPR.
METHODS: The FaciLItated hospital-based ECPR via Helicopter Transport (FLIGHT-to-ECPR) Study is a single-center prospective observational cohort study (August 2021-December 2025). Adults (18-75 years) with refractory VF/VT OHCA meeting Minnesota Mobile Resuscitation Consortium eligibility criteria were included. The pathway used parallel EMS and Helicopter-EMS activation with intra-arrest mechanical-CPR transport to a hospital-based ECMO center. Outcomes were compared 1:1 with a matched cohort treated under the standard ground-transport ECPR protocol, matched on low-flow time. The primary outcome was survival to discharge with favorable neurologic status (CPC 1-2).
RESULTS: Forty-five patients underwent FLIGHT activation; 27 (60%) received ECPR (veno-arterial ECMO during cardiac arrest). Mean age was 55.2 ± 15.0 years; 83.7% were witnessed arrests and 69.0% received bystander CPR. Mean 9-1-1-to-hospital arrival time was 70.3 ± 18.5 min; HEMS scene and flight times were 18.0 ± 11.6 and 18.6 ± 6.3 min, respectively. Among cannulated patients, low-flow time was 85.9 ± 29.3 min. Overall favorable neurologic survival (CPC 1-2) was 33.3% (15/45): 25.9% (7/27) in cannulated patients and 44.4% (8/18) in non-cannulated patients achieving ROSC or meeting termination criteria. In matched ECPR patients (n = 27/group), low-flow times were similar (85.9 ± 29.3 vs. 87.1 ± 29.2 min; p ≥ 0.99), with identical favorable neurologic survival (25.9%; p ≥ 0.99). No differences were observed in cannulation performance, ECMO duration, or hospital length of stay.
CONCLUSIONS: A HEMS-facilitated, hospital-based ECPR strategy is feasible and safely expands rural access to advanced resuscitation while preserving neurologic outcomes comparable to standard ground-transport ECPR. Geography alone need not preclude ECPR when systems are optimized to maintain timely reperfusion.
RESEARCH QUESTION/HYPOTHESIS: We hypothesized that a Helicopter-EMS (HEMS)-facilitated, hospital-based ECPR pathway could expand rural access while preserving clinical outcomes comparable to standard ground-transport ECPR.
METHODS: The FaciLItated hospital-based ECPR via Helicopter Transport (FLIGHT-to-ECPR) Study is a single-center prospective observational cohort study (August 2021-December 2025). Adults (18-75 years) with refractory VF/VT OHCA meeting Minnesota Mobile Resuscitation Consortium eligibility criteria were included. The pathway used parallel EMS and Helicopter-EMS activation with intra-arrest mechanical-CPR transport to a hospital-based ECMO center. Outcomes were compared 1:1 with a matched cohort treated under the standard ground-transport ECPR protocol, matched on low-flow time. The primary outcome was survival to discharge with favorable neurologic status (CPC 1-2).
RESULTS: Forty-five patients underwent FLIGHT activation; 27 (60%) received ECPR (veno-arterial ECMO during cardiac arrest). Mean age was 55.2 ± 15.0 years; 83.7% were witnessed arrests and 69.0% received bystander CPR. Mean 9-1-1-to-hospital arrival time was 70.3 ± 18.5 min; HEMS scene and flight times were 18.0 ± 11.6 and 18.6 ± 6.3 min, respectively. Among cannulated patients, low-flow time was 85.9 ± 29.3 min. Overall favorable neurologic survival (CPC 1-2) was 33.3% (15/45): 25.9% (7/27) in cannulated patients and 44.4% (8/18) in non-cannulated patients achieving ROSC or meeting termination criteria. In matched ECPR patients (n = 27/group), low-flow times were similar (85.9 ± 29.3 vs. 87.1 ± 29.2 min; p ≥ 0.99), with identical favorable neurologic survival (25.9%; p ≥ 0.99). No differences were observed in cannulation performance, ECMO duration, or hospital length of stay.
CONCLUSIONS: A HEMS-facilitated, hospital-based ECPR strategy is feasible and safely expands rural access to advanced resuscitation while preserving neurologic outcomes comparable to standard ground-transport ECPR. Geography alone need not preclude ECPR when systems are optimized to maintain timely reperfusion.