Emergency physicians Dr. Brian Grunau (right) and Dr. Dan Kalla (left). ECMO is being used to save patients experiencing cardiac arrest.

Improving the Odds

Promise Magazine: Spring/Summer 2016
by Joseph Dubé

Cardiac arrest is one of the leading causes of death in BC and across Canada. What’s more, survival rates among people who experience a heart attack outside of a hospital are particularly low. Approximately nine out of 10 people who suffer a cardiac arrest outside of a hospital do not survive, even with full conventional interventions. Now, thanks to a first-in-Canada cardiac resuscitation program at St. Paul’s, the odds of surviving cardiac arrest are improved.

St. Paul’s new emergency department-based ECPR (extracorporeal cardio-pulmonary resuscitation) program is the first of its kind in Canada, incorporating the use of an ECMO device (extracorporeal membrane oxygenation) in resuscitating victims of out-of-hospital cardiac arrest.

“The ECMO machine is a pump external to the patient that provides the functionality of the heart and lungs,” explains Dr. Brian Grunau, emergency physician and ECPR program leader at St. Paul’s. “By establishing a connection between the machine and the patient having a cardiac arrest, you’re able to effectively bypass the heart, giving doctors time correct the cause of the arrest. It can definitely be a game changer for certain patients.”

ECPR programs like the one at St. Paul’s have been established in a small number of cutting-edge resuscitation centres in other areas of the world, where preliminary data has demonstrated large improvements in survival among select patient groups.

Prime candidates for ECPR

“Candidates are previously healthy people who have had a witnessed cardiac arrest and bystander CPR, so that the organs have been sustained with blood flow,” says Grunau. “For the best chance of a good outcome these patients need to be identified, transported to hospital, and placed on ECMO as soon as possible—definitely under 70 minutes from the arrest. It’s a very tight window.”

Emergency department head Dr. Dan Kalla has overseen the stepwise implementation of the program over the last two years and cites organization as a critical factor to ECPR’s success.

“In the Vancouver area, paramedics treat about 400 cardiac arrests per year, and it was shocking to learn that one-third of those patients are under the age of 60,” says Kalla. “This complex program is a joint venture between multiple programs in our hospital, namely cardiovascular surgery, perfusion, critical care, cardiology and the emergency department. It represents a high level of co-operation and dedication. While all the components were there, coalescing them into a formalized service has involved training, awareness and equipment.”

To learn how you can support the resuscitation program at St. Paul’s Teck Emergency Centre, please contact St. Paul’s Foundation at 604-682-8206 or donate online at http://helpstpauls.com/donate