ID:195 FC-D02-9 Implementation of Prehospital ECPR in a Regional System: Analysis of 18 Cases From the Utsunomiya Model

Background: In our medical control (MC) region, serving approximately 600,000 residents, a prehospital extracorporeal cardiopulmonary resuscitation (PECPR) system has been in operation since 2022. To our knowledge, this is the only ECMO center–led PECPR system in Japan. We evaluated its feasibility and clinical validity. Methods: We retrospectively reviewed 18 consecutive patients who underwent PECPR between January 2022 and April 2025. During the initial emergency call, the fire department dispatch center activated the ECPR team. Patient selection prioritized the presence of signs of life (SOL) in addition to standard ECPR criteria. The primary outcome was favorable neurological outcome, defined as a Cerebral Performance Category (CPC) score of 1 or 2. Secondary outcomes included survival to discharge and complications. Results: In 12 of 18 patients, cardiac arrest had already been recognized at the time of dispatch. The mean age was 57 years, and 83.3% were male. SOL was present in 66.7%, the arrest was witnessed in 66.7%, and bystander CPR was performed in 77.8%. Initial rhythms were VF/VT in 33.3% and PEA in 50.0%. The median duration of conventional CPR before ECMO initiation was 27 minutes [22–34], cannulation time was 10.5 minutes [7.3–14.8], and low-flow time was 36 minutes [32–49]. Favorable neurological outcome was achieved in 25.0% of patients, survival to discharge in 56.3%, and complications occurred in 5.6%. Among patients with SOL, favorable neurological outcome was 36.4% and survival to discharge was 63.6%. Compared with the early implementation phase, the later phase showed improvements in the proportion of patients with SOL (56% to 78%), favorable neurological outcome (14% to 33%), and survival to discharge (29% to 78%). Conclusion: The PECPR system in our region appears feasible. Prioritizing SOL may be an effective strategy for patient selection, and outcomes improved as the system matured over time.