Mobile ECMO Truck Matches In-Hospital Survival in Cardiac Arrest

The Race Against Low-Flow Time in Refractory Cardiac Arrest

Refractory out-of-hospital cardiac arrest carries a dismal prognosis under conventional resuscitation protocols, prompting the adoption of extracorporeal cardiopulmonary resuscitation (ECPR) as a critical rescue therapy. Multiple meta-analyses indicate that ECPR can improve neurologically favorable survival compared to standard measures, particularly when initiated for shockable rhythms, with one large review demonstrating survival at hospital discharge of 20% for ECPR versus 3.3% for conventional CPR [1, 2, 3, 4]. However, the clinical benefit of ECPR is strictly time-dependent, as prolonged low-flow intervals (the duration from the initial emergency call to the establishment of extracorporeal blood flow) sharply reduce the odds of a meaningful recovery [5, 6, 4]. Because geographic distance frequently prevents eligible patients from reaching specialized in-hospital ECPR centers within this narrow therapeutic window, clinicians are increasingly looking for ways to bring the intervention directly to the patient. Deploying a specialized mobile unit to initiate extracorporeal life support directly at the scene offers a practical solution to reduce these delays, a strategy recently associated with a 25% rate of survival with good neurological function in prehospital cohorts [5].

Deploying a Fluoroscopy-Enabled Mobile Unit

To address the critical time delays inherent in transporting patients to specialized centers, researchers investigated whether a purpose-built mobile extracorporeal membrane oxygenation (ECMO) truck could deliver scene-based resuscitation effectively. They hypothesized that this mobile unit, equipped with fluoroscopy (real-time X-ray imaging to guide precise vascular catheter placement), would achieve neurologically favorable survival rates comparable to a mature in-hospital system. To test this, the investigators evaluated the feasibility, procedural performance, and clinical outcomes of a sustained prehospital ECPR program integrated within a regional cardiac arrest system of care. They conducted a single-center retrospective analysis of a prospectively collected registry within the Minnesota Mobile Resuscitation Consortium.

The study included adults aged 18 to 75 years who experienced refractory ventricular fibrillation or ventricular tachycardia out-of-hospital cardiac arrest. Patients treated under the mobile ECMO truck protocol were compared with a matched cohort treated under the standard in-hospital ECPR pathway. To isolate the effect of the treatment location, the researchers matched the mobile cohort and the in-hospital cohort based on low-flow time, ensuring that the duration of ischemia was equivalent between the groups. The investigators then compared baseline characteristics, laboratory values, time intervals, cannulation metrics, and overall outcomes. The primary outcome was survival to hospital discharge with a favorable neurological status, providing a rigorous measure of meaningful clinical recovery rather than mere survival.

Procedural Metrics: Cannulation on the Scene

In the retrospective analysis, a total of eight patients underwent ECMO truck activation. To ensure a rigorous comparison of clinical and procedural outcomes, these eight mobile-unit patients were matched to eight in-hospital controls who received standard extracorporeal resuscitation. The researchers confirmed that baseline characteristics were similar between the two groups, allowing for a direct evaluation of the mobile intervention without significant confounding from underlying patient demographics or initial clinical status.

A critical metric in extracorporeal resuscitation is the duration of ischemia before reperfusion, as every minute without flow degrades neurological viability. The analysis demonstrated that the total low-flow time was 74.8 (standard deviation [SD] 19.8) minutes in the ECMO truck group, which closely aligned with the 73.0 (SD 22.9) minutes observed in the in-hospital control group (p= 0.87). Beyond overall ischemic time, the study evaluated the procedural efficiency of initiating extracorporeal support in a mobile environment. The time from initial vascular access to establishing full circuit flow reflects the technical difficulty of the procedure. The needle-stick-to-ECMO flow times were 7.5 (SD 3.1) minutes in the ECMO truck group, compared to 12.0 (SD 10.8) minutes in the in-hospital control group (p= 0.71). These metrics indicate that complex vascular cannulation performed on the scene inside a purpose-built vehicle is procedurally comparable to the same intervention performed within a controlled, well-lit hospital setting.

Neurological Survival and Clinical Feasibility

The primary clinical outcome of the study demonstrated identical success rates between the prehospital and hospital-based interventions. Specifically, the researchers found that neurologically favorable survival was 25% in the ECMO truck cohort. This result exactly mirrored the standard pathway, as neurologically favorable survival was also 25% in the matched in-hospital controls (p= >0.99). By achieving equivalent rates of meaningful neurological recovery, the data suggest that moving the site of extracorporeal cannulation to the field does not compromise patient outcomes, provided that ischemic durations are strictly controlled.

Based on these matched survival rates and the previously noted cannulation metrics, the authors concluded that a sustained, protocolized prehospital ECPR program using a purpose-built ECMO truck is feasible and achieves outcomes comparable to an established in-hospital system when matched on low-flow time. Ultimately, this single-center feasibility study demonstrates that a mobile ECPR program can be implemented safely and with acceptable procedural performance. For practicing emergency physicians and cardiologists managing regional cardiac arrest networks, these findings offer a practical framework for delivering complex reperfusion therapies directly to the scene of the arrest. By bypassing transport delays, mobile units could significantly expand the pool of eligible patients who would otherwise fail to reach a specialized center within the critical therapeutic window.

References

1. Scquizzato T, Bonaccorso A, Swol J, et al. Refractory out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta-analysis of randomized trials.. Artificial organs. 2023. doi:10.1111/aor.14516

2. Reddy S, Garcia S, Hostetter L, et al. Extracorporeal-CPR Versus Conventional-CPR for Adult Patients in Out of Hospital Cardiac Arrest– Systematic Review and Meta-Analysis. Journal of Intensive Care Medicine. 2024. doi:10.1177/08850666241303851

3. Pagura L, Fabris E, Rakar S, et al. Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis.. Journal of critical care. 2024. doi:10.1016/j.jcrc.2024.154882

4. Escareño MDLAL, Dueñas CAF, Gómez FJB, et al. Extracorporeal versus Conventional Cardiopulmonary Resuscitation in Refractory Cardiac Arrest: Systematic Review of Survival and Neurological Outcomes. Salud, Ciencia y Tecnología. 2026. doi:10.56294/saludcyt20262508

5. Leroux L, Dennis-Benford NB, Bergeron A, et al. Impact of prehospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest on survival with good neurological function: a systematic review and meta-analysis.. Resuscitation plus. 2025. doi:10.1016/j.resplu.2025.100974

6. Moreau A, Su F, Annoni F, Taccone FS. Extracorporeal cardiopulmonary resuscitation: a comparison of two experimental approaches and systematic review of experimental models.. Intensive care medicine experimental. 2024. doi:10.1186/s40635-024-00664-1