Cardiac resuscitation trial at St. Paul’s Hospital the first of its kind in Canada
Photo credit: Ermin Badzak
St. Paul’s Hospital and BC Emergency Health Services (BCEHS) are conducting a landmark trial that could increase the survival rate of seemingly healthy people who suffer a sudden cardiac arrest outside of a hospital setting.
The trial is called BC Extracorporeal Cardiopulmonary Resuscitation Trial for Refractory Out of Hospital Cardiac (ECPR) and is the first of its kind in Canada. It involves a rapid, coordinated response by both paramedics and a cardio team at St. Paul’s Hospital.
Thirty advanced-care paramedics in Vancouver and the North Shore have been trained to recognize, care for and quickly transport patients who meet pre-established criteria to St. Paul’s Hospital. The protocol focuses on patients who would be most likely to benefit: previously healthy and relatively young persons with sudden cardiac arrest who receive rapid CPR before arrival at the hospital.
In the trial, paramedics attach a portable automatic chest-compression system to a patient who has suffered cardiac arrest to provide continuous, high-quality compressions while being transported in the ambulance. CPR cannot be effectively or safely delivered in a moving vehicle. Using the automatic machine allows paramedics to focus on providing advanced cardiac care, monitoring the patient and getting to the hospital quickly.
Upon arrival at St. Paul’s, the patient is met by a hospital–based team that initiatives a life-saving therapy called ECMO-CPR (Extracorporeal Membrane Oxygenation – Cardiopulmonary Resuscitation). The ECMO machine is an external pump that does the job of a patient’s heart and lungs while doctors work to fix what caused the arrest.
The goal is to get the patient to St. Paul’s Hospital and started on ECMO within 60 minutes of first responders initially administering CPR.
This protocol has already saved the lives of several patients with cardiac arrest, including Vancouver media and IT manager Genya Kaplun. His girlfriend found him unresponsive on his apartment balcony in February 2014, at age 38. He was in full-blown cardiac arrest. He was taken by ambulance to St. Paul’s Hospital and was revived with ECPR.
The trial is expected to last two years. Funding came from a number of sources, including Providence Health Care Research Institute. U.S. medical-devices company Physio-Control Inc. has provided vital equipment for the trial.
- Cardiac arrest is among the leading causes of death in BC and across Canada.
- In 2015, paramedics responded to 627 suspected cardiac arrests in Vancouver and North Vancouver.
- Only about 14 per cent of patients survive out of hospital cardiac arrests.
- Researchers hope to eventually triple that survival rate using this new therapy.
Terry Lake, Health Minister –
“This promising trial could help save precious lives thanks to the close collaboration, innovative research and patient-focused approach of our hospital and pre-hospital care teams.”
Dr. Brian Grunau, BC ECPR Study Principle Investigator, Department of Emergency Medicine at St. Paul’s Hospital –
“St. Paul’s extensive experience in advanced innovative cardiac therapies, in partnership with BCEHS’s renowned track record in pre-hospital resuscitation, gives this cutting-edge program great potential to improve the survival rates of cardiac-arrest patients.”
Dr. William Dick, Vice-President Medical Programs, BC Emergency Health Services, an agency of the Provincial Health Services Authority –
“Our paramedics witness the devastating and often debilitating impact of unexpected cardiac arrests first-hand. We’re proud to play an integral role in this trial that could further improve survival rates for patients who suffer out-of-hospital cardiac arrests.”
Brian Twaites, advanced care paramedic, BC Emergency Health Services –
“Usually we work on resuscitating the patient at the scene and then, once stabilized, continue to provide advanced cardiac care and monitor the patient during transport to the hospital. During this trial, we will begin transporting some patients earlier, providing continuous, safe and effective CPR as well as continuing advanced care while en route to the hospital.”
Providence Health Care (PHC) is one of Canada's largest faith-based health care organizations, operating 17 health care sites in Greater Vancouver. PHC operates one of two adult academic health science centres in the province – St. Paul’s Hospital – that performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardio-pulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health and is home to the B.C. Centre for Excellence in HIV/AIDS. www.providencehealthcare.org.
BC Emergency Health Services (BCEHS) is responsible for the delivery and governance of pre-hospital emergency medical care and inter-facility patient transfer services through the BC Ambulance Service and the BC Patient Transfer Network. BCEHS is supported by the Provincial Health Services Authority (PHSA). For more information, please visit www.bcehs.ca or follow us on Twitter @BC_EHS.
The Provincial Health Services Authority (PHSA) plans, manages and evaluates selected specialty and province-wide health care services across BC, working with the five geographic health authorities to deliver province-wide solutions that improve the health of British Columbians. For more information, visit www.phsa.ca or follow us on Twitter @PHSAofBC.
Dr. Michael O'Shaughnessy