Out-of-Hospital Extracorporeal Life Support—Emergency and Resident Physicians Point of View

Objectives: Extracorporeal life support (ECLS) is increasingly used in out-of-hospital (OoH) settings. Selected cities are already offering ambulance-based ECLS for emergency aid. The aim of this study was to evaluate the possibility and acceptance of an OoH ECLS implantation during emergency service or at a resident’s office by a specialized team.

Methods: For this study, emergency (P_e) as well as resident (P_r) physicians were interviewed in regard to their knowledge and experience with ECLS. Additionally, general acceptance of OoH ECLS usage was inquired. To classify the obtained results, personal working experience, number of patients/emergency calls, infrastructural information, and emergency training status were categorized.

Results: A collective of 55 of physicians (P_e: 38; P_r: 17) was interviewed for this ongoing study. Physicians were specialized either in anesthesiology (n = 27), internal (n = 15), or general (n = 5) medicine and surgery (n = 2) not specified: n = 6. P_e was experienced in ground (97%) and air rescue (37%) as well as in intensive care transportation (53%). 95%/P_e and 76%/P_r attended certified courses including BLS and/or ALS within the previous 5 years.

P_e reported an estimated number of 12.59 patients (PAT) needing CPR in emergency service during a one-year period. Catecholamines were necessary for 41.69 PAT/year/P_e and invasive circulatory support for 1.14 PAT/year/P_e. ECLS was used in 0.8 PAT/year/P_e; 63% of the P_e preferred an urgent hospitalization for instable PAT instead of pre-transportation ECLS implantation. Benefits of OoH ECLS are particularly seen for longer transportation and for prolonged CPR. However, only 11% of the P_e reported advanced practical experience with ECLS (theoretical knowledge: 63%).

In residents sector, 41% reported at least one situation requiring CPR for a one-year period. An average of 10.94 PAT/year/P_r showed indication for emergency hospitalization with obligate monitoring, 0.59 PAT/year/P_r in a critical condition. P_r mainly had theoretical (47%) or no (29%) knowledge about ECLS. However, training and information courses are requested by 70% of the interviewed physicians.

Conclusion: At the moment, P_e and P_r rate the OoH usage of ECLS critically or are not aware of this therapeutic option. However, the majority of the interviewed physicians had no advanced knowledge or experience about ECLS. Therefore, we highly recommend advanced education and the establishment of ECLS networks.

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