Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is highly time-dependent. In areas with limited access to ECPR centers, patients who experience cardiac arrest far from hospitals may lose the chance to receive this therapy. Our institution has operated a prehospital ECPR program since 2016. In Japan, clinical engineers (CEs) are nationally licensed professionals with expertise in advanced medical devices. We introduce their role as device specialists in prehospital ECPR. Clinical Course/ Activities: We performed prehospital ECPR in 13 patients located more than 10 km from our hospital. CEs participated in all cases. The decision to initiate ECPR was made by the physician in the response vehicle, after which prehospital ECMO team including two CEs mobilized with a target departure time within 5 minutes. Rendezvous points, mainly fire stations, were determined en route. At the scene, CEs prepared ECMO, established ventilation and monitoring, and managed the devices during transport. To ensure consistent performance outside the hospital, we implemented structured simulation training with physicians, including equipment preparation and field cannulation. During interfacility transport after ECMO initiation, a CE accompanied the patient and was trained to manage anticipated device-related problems independently. Discussion: Assigning a dedicated device specialist enables physicians to focus on clinical assessment, cannulation, and decision-making. This task specialization supports early problem recognition, standardized responses, and maintenance of the same level of device reliability as in the hospital in austere environments. Conclusion: The involvement of clinical engineers as device specialists is essential for maintaining quality of care and ensuring safe prehospital ECPR.
Shin et al. (Mon,) studied this question.