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New protocol helps some cardiac arrest patients survive ‘certain death’

COLUMBUS, Ohio – It’s called an ECPR alert and more people are walking away from a type of cardiac arrest that is nearly always fatal, thanks to this new protocol being tested at The Ohio State University Wexner Medical Center.

“This protocol is for people who are in ventricular fibrillation or refractory ventricular tachycardia, which are irregular heart rhythms that aren’t compatible with life and resist being shocked back to normal,” said Dr. Ernest Mazzaferri Jr., medical director of The Ohio State University Richard M. Ross Heart Hospital. “Typically, if they don’t respond to getting shocked, these patients would die in the field because we didn’t have any options to save them. Now, in certain situations, we have had patients survive and walk out of the hospital.”

An ECMO machine is prepared in a cath lab at The Ohio State University Wexner Medical Center. It allows a cardiac arrest patient’s heart to rest while doctors work to find the problem and restore normal heart rhythm.

Currently, only about 10 percent of people survive a sudden cardiac arrest that happens in the field, even fewer survive with normal neurologic function. The ECPR alert is designed to change those numbers.

Columbus EMS personnel follow their protocol for ventricular fibrillation. If the patient remains in this rhythm after three defibrillation attempts, they call an ECPR alert to Ohio State Wexner Medical Center. Medics put a mechanical CPR device on the patient for transport straight to the cardiac catheterization lab where a team is assembled and waiting.

“Between the field and the cath lab it’s critical to have good CPR to keep blood and oxygen moving to the brain

EMTs with the Columbus Division of Fire connect a patient to an automatic CPR machine in an ambulance. It’s a vital step in a new protocol that’s initiated when a patient’s heart can’t be shocked back into rhythm in the field.

and essential organs,” said Dr. Konstantinos Dean Boudoulas, section leader of interventional cardiology at Ohio State and one of the physicians leading the protocol.

Once in the cath lab, the patient is put on extracorporeal membrane oxygenation (ECMO) which takes over the functions of the heart and lungs.

“This allows the heart and lungs to rest while we find the problem and get the heart restarted and beating well, said Dr. Bryan Whitson, a cardiothoracic surgeon who leads the ECMO program at Ohio State.

Mark Bradford thanks members of the Columbus Division of Fire for saving his life after he went into sudden cardiac arrest. Paramedics were able to initiate a new, life-saving protocol being tested in partnership with The Ohio State University Wexner Medical Center

The new system worked for 68-year-old Mark Bradford of Columbus. He collapsed while on his morning walk and woke up days later after treatment in the hospital.

“Without that protocol, I wouldn’t be alive. I’m very fortunate that they were trained in it and used it, and that I was out in the park where someone saw me,” Bradford said.

The ECPR protocol has only been tested in a few small studies recently, and so far the limited data shows an increase to about 40 percent chance of survival.

“We certainly need more trials and more data,” Mazzaferri said. “Perhaps some years from now, ECPR will be more routine and saving more lives across the U.S.”