Treating heart attack patients at the roadside with ECMO SUB30

25 Sep 2019

A clinical study we are funding has now launched that could improve survival and recovery rates among the thousands of people who suffer a cardiac arrest outside of hospital every year. 

It aims to prove that placing suitable patients on "ECMO" within 30 minutes of the 999 call, could be lifesaving.

When someone suffers a cardiac arrest outside of hospital, conventional resuscitation methods are used to get the person’s heart restarted. Unfortunately, even if the patient’s heart is able to get restarted by these methods, their vital organs – including the brain – have often been starved of oxygen for so long by this point that they may be left with significant brain damage. 

Patients who suffer cardiac arrests outside of hospital unfortunately have very poor survival rates. Of the 4,389 patients that London Ambulance Service attempted to resuscitate last year, only 395 (9 per cent) of those patients survived and were able to return home, despite the best efforts of emergency responders. 

In the event of a cardiac arrest in hospital, some patients can be supplied with well oxygenated blood using a method called Extra Corporeal Membrane Oxygenation (ECMO) to keep their organs functioning whilst the cause for the cardiac arrest is treated; giving the patient the best possible chance of recovery.  

Delivering life-saving intervention

Now, a team of experts from Barts Health NHS Trust, London’s Air Ambulance Charity and London Ambulance Service have joined together with Queen Mary University of London in a pioneering trial. This Sub30 trial that we are joint funding with London's Air Ambulance, aims to offer the same opportunity to suitable cardiac arrest patients outside of hospital and will see ECMO used at the roadside for the first time in the UK.

Simon Finney, Chief Investigator and ECMO Consultant at Barts Health NHS Trust says: “After 20 minutes of CPR, not only does the likelihood of a patient’s heart restarting dramatically decrease, but the risk of severe brain injury should they survive drastically increases. That’s why we consider 20 minutes to be the critical point at which our intervention would be in the best interest of the patient.

“Over the next year, we hope to learn whether or not it’s even possible for us to. If we’re able to show it is possible then our next step would be to roll this study out on a larger scale and work out more formally if it helps improve outcomes for patients.”

A London’s Air Ambulance rapid response vehicle staffed by three consultant doctors and one Advanced Paramedic in Critical Care from London Ambulance Service will be on standby across the Barts Health Heart Attack Centre catchment area, and respond to cardiac arrest emergency calls. Carrying advanced medication, equipment and treatments that are usually only found in hospital ECMO departments, the team will take the hospital to the patient to deliver this potentially life-saving intervention.

Patients’ organs will be supplied with pressured and oxygenated blood, giving the patient and the medical team time to transport them to the Heart Attack Centre at St Bartholomew’s Hospital, London where the ECMO can be continued and the reason for the cardiac arrest investigated without the concern of the brain and other organs deteriorating due to a lack of oxygen.

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