Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option for refractory cardiac arrest patients, but it has mostly been restricted to hospitals with on-site cardiothoracic surgery support. We report the implementation of the ECPR protocol in a rural hospital without on-site cardiothoracic surgery.

The ECPR protocol was initiated in June 2020 in North Karelia Central Hospital in Eastern Finland, in collaboration with the tertiary center, Kuopio University Hospital, where patients were transferred for further treatment. After successful initiation of the ECPR protocol, the emergency ECMO treatment was extended to patients with refractory cardiogenic shock or respiratory failure. We retrospectively analyzed patient outcomes.

Between June 2020 and June 2024, 15 patients suffering from refractory cardiac arrest were treated with ECPR. The median age of the patients was 56 years [interquartile range (IQR) 46–63]. Ten (67 %) patients were treated because of out-of-hospital cardiac arrest and five (33 %) patients because of in-hospital cardiac arrest. The median time from cardiac arrest to VA-ECMO was 58 (IQR 37–65) min. At six months, three (20 %) ECPR patients were alive with a favorable neurological outcome. In addition, one patient with cardiogenic shock was treated successfully with VA-ECMO and one respiratory failure patient with VV-ECMO.

The ECPR protocol involving the initiation of emergency VA-ECMO in a hospital without on-site cardiac surgery and transfer to a tertiary center for further treatment is feasible and led to the survival of 20 % of the ECPR-treated patients and 25 % of all VA-ECMO-treated patients.