{
    "abstract": "The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20\u00a0min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60\u00a0min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients.\nThe ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18-50\u00a0years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45\u00a0min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12\u00a0months.\nThe ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment.\nClinicaltyrials.gov under NCT04620070, registration date 3 November 2020.",
    "authors": [
        {
            "affiliation": "Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands. s.ali@erasmusmc.nl.\nDepartment of Anaesthesiology, Erasmus Medical Centre, Rotterdam, 3015 GD, the Netherlands. s.ali@erasmusmc.nl.\nMinistry of Defence, Royal Netherlands Air Force, Breda, 4820 ZB, the Netherlands. s.ali@erasmusmc.nl.",
            "firstname": "Samir",
            "initials": "S",
            "lastname": "Ali"
        },
        {
            "affiliation": "Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, 3015 GD, the Netherlands.\nHelicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands.",
            "firstname": "Xavier",
            "initials": "X",
            "lastname": "Moors"
        },
        {
            "affiliation": "Helicopter Emergency Medical Services, Netwerk Acute Zorg Noordwest, Amsterdam University Medical Centre, Amsterdam, 1081 HV, the Netherlands.",
            "firstname": "Hans",
            "initials": "H",
            "lastname": "van Schuppen"
        },
        {
            "affiliation": "Helicopter Emergency Medical Service, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands.\nDepartment of Anaesthesiology, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands.",
            "firstname": "Lars",
            "initials": "L",
            "lastname": "Mommers"
        },
        {
            "affiliation": "Helicopter Emergency Medical Service, University Medical Centre Groningen, Groningen, 9713 GZ, the Netherlands.",
            "firstname": "Ellen",
            "initials": "E",
            "lastname": "Weelink"
        },
        {
            "affiliation": "Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.",
            "firstname": "Christiaan L",
            "initials": "CL",
            "lastname": "Meuwese"
        },
        {
            "affiliation": "Department of Intensive Care, Amphia Hospital, Breda, 4818 CK, the Netherlands.",
            "firstname": "Merijn",
            "initials": "M",
            "lastname": "Kant"
        },
        {
            "affiliation": "Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands.",
            "firstname": "Judith",
            "initials": "J",
            "lastname": "van den Brule"
        },
        {
            "affiliation": "Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, 2333 ZA, the Netherlands.",
            "firstname": "Carlos Elzo",
            "initials": "CE",
            "lastname": "Kraemer"
        },
        {
            "affiliation": "Department of Intensive Care Medicine, Amsterdam University Medical Centre, Amsterdam, 1105 AZ, the Netherlands.",
            "firstname": "Alexander P J",
            "initials": "APJ",
            "lastname": "Vlaar"
        },
        {
            "affiliation": "Department of Intensive Care, Haga Teaching Hospital, the Hague, 2545 AA, the Netherlands.",
            "firstname": "Sakir",
            "initials": "S",
            "lastname": "Akin"
        },
        {
            "affiliation": "Department of Critical Care, University Medical Centre Groningen, Groningen, 9713 GZ, the Netherlands.",
            "firstname": "Annemiek Oude",
            "initials": "AO",
            "lastname": "Lansink-Hartgring"
        },
        {
            "affiliation": "Department of Intensive Care, St. Antonius Hospital, Nieuwegein, 3435 CM, the Netherlands.",
            "firstname": "Erik",
            "initials": "E",
            "lastname": "Scholten"
        },
        {
            "affiliation": "Department of Intensive Care, Catharina Hospital, Eindhoven, 5623 EJ, the Netherlands.",
            "firstname": "Luuk",
            "initials": "L",
            "lastname": "Otterspoor"
        },
        {
            "affiliation": "Department of Intensive Care, OLVG, 1091 AC, Amsterdam, the Netherlands.",
            "firstname": "Jesse",
            "initials": "J",
            "lastname": "de Metz"
        },
        {
            "affiliation": "Department of Intensive Care, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands.",
            "firstname": "Thijs",
            "initials": "T",
            "lastname": "Delnoij"
        },
        {
            "affiliation": "Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands.",
            "firstname": "Esther M M",
            "initials": "EMM",
            "lastname": "van Lieshout"
        },
        {
            "affiliation": "Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands.",
            "firstname": "Robert-Jan",
            "initials": "RJ",
            "lastname": "Houmes"
        },
        {
            "affiliation": "Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands.",
            "firstname": "Dennis den",
            "initials": "DD",
            "lastname": "Hartog"
        },
        {
            "affiliation": "Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.",
            "firstname": "Diederik",
            "initials": "D",
            "lastname": "Gommers"
        },
        {
            "affiliation": "Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.\nHelicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands.",
            "firstname": "Dinis",
            "initials": "D",
            "lastname": "Dos Reis Miranda"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1186/s13049-024-01198-x\n10.1080/10903127.2020.1752868\n10.1016/j.resuscitation.2017.01.005\n10.1186/s13054-022-03994-2\n10.1097/CCM.0b013e31827ca4c8\n10.1186/s13054-023-04384-y\n10.1186/s40560-020-00457-0\n10.1186/s13054-017-1744-8\n10.1016/j.resuscitation.2021.09.004\n10.1093/icvts/ivac219\n10.1136/bmjopen-2014-007510\n10.1136/bmjopen-2016-014333\n10.1016/j.resuscitation.2014.08.011\n10.1016/j.jval.2016.01.003\n10.1016/j.jval.2014.08.1791\n10.1016/j.resuscitation.2021.07.034\n10.1056/NEJMoa1109148\n10.1001/jama.2013.278483\n10.1186/s13054-020-2773-2\n10.1016/j.resuscitation.2022.04.003\n10.1016/S0140-6736(08)60958-7\n10.1080/10903127.2017.1356412\n10.1007/s00134-016-4536-8\n10.1097/CCM.0b013e3181feb339\n10.1016/j.resuscitation.2015.07.016\n10.1016/S0140-6736(20)32338-2\n10.1001/jama.2022.1025\n10.1186/s13054-022-04199-3\n10.1016/j.resuscitation.2016.01.019\n10.1016/j.resuscitation.2017.04.014\n10.1016/j.resuscitation.2016.12.011\n10.1016/j.resuscitation.2014.01.031\n10.1016/j.resuscitation.2022.10.006\n10.1056/NEJMoa2204511",
    "journal": "Scandinavian journal of trauma, resuscitation and emergency medicine",
    "keywords": [
        "Advanced cardiac life support",
        "Cardiopulmonary resuscitation",
        "Extracorporeal membrane oxygenation",
        "Out-of-hospital cardiac arrest"
    ],
    "methods": null,
    "publication_date": "2024-04-18",
    "pubmed_id": "38632661\n32286908\n28109995\n35501884\n23388518\n36879338\n32549988\n28637497\n34509554\n36000900\n26100026\n28720612\n25438253\n27325326\n27201788\n34389450\n23150959\n24084923\n32087741\n35421535\n18603291\n28841080\n27647331\n21057309\n26477701\n33197396\n35191923\n36303227\n26851058\n28414164\n28007504\n24530251\n36243225\n36720132",
    "results": null,
    "title": "A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study.",
    "xml": "<Element 'PubmedArticle' at 0x78850303cb30>"
}