By Anya Sostek
Pittsburgh Post-Gazette
PITTSBURGH—On June 11, as Mary Fischer was making pizza for dinner, her boyfriend showed up early to grab some freshly sliced pepperoni.
After Fischer, 51, went outside to plug in the pizza oven, she collapsed. Her boyfriend heard a noise and went to check on her — at which point he noticed that her heart had stopped, called 911 and started CPR.
City of Pittsburgh EMS arrived at her West End house minutes later. Just a few years ago, they would have stayed at her residence for 30, 40 minutes or longer, using everything at their disposal to try to restart her heart. Her odds wouldn’t have been good: Historically, only about 1 in 10 people survive out-of-hospital cardiac arrests.
Instead, they tried to restart her heart for about 10 minutes. And then — because she was a good candidate for a pilot program being tested by Allegheny Health Network — they loaded her into an ambulance, took her to Allegheny General Hospital and hooked her up to a machine that essentially took over her heart and lung function.
That device is called an extracorporeal membrane oxygenation machine, or ECMO machine. And when it’s used in certain patients who suffer cardiac arrests, their odds of survival jump dramatically.
As of this month, AHN officially offers extracorporeal CPR, or ECPR, as its protocol for qualifying patients around the clock. The hospital system has been testing it in a limited pilot program since 2021. UPMC Presby also uses ECPR.
“There’s emerging evidence that the change in protocol for cardiac arrest resuscitation is life-saving,” said Tyler VanDyck, co-director of the AHN Cardiothoracic Surgical ICU and medical director of ECMO at AGH. “The evidence is quite overwhelming in that regard.”
The University of Minnesota began conducting the first randomized clinical trial of ECMO-facilitated CPR in August 2019, comparing survival rates of those who suffered out-of-hospital cardiac arrests treated by traditional CPR and those treated with an ECMO machine.
About 10 months in, they found that just one in 15 patients (7%) treated with traditional CPR protocols survived hospital discharge, versus six of 14 (43%) treated with ECMO. The results were so striking that the university’s ethics board ordered the study to be halted, determining that it would be unethical to continue treating them by the standard method.
Implementing an ECMO-facilitated CPR program is complicated, however, requiring minute-by-minute coordination between hospitals and EMS teams. The COVID-19 pandemic also slowed implementation considerably, as emergency rooms and EMS teams focused on treating COVID-19 patients, who also benefited from ECMO machines.
Through its pilot program, in the last year, AGH has administered ECPR to seven patients who went into cardiac arrest outside of the hospital. Three of them — 43% — survived.
“Without ECPR, three of our patients in the past year would be dead,” said VanDyck. “They’re now at home spending time with their loved ones, three different families.”
One of those patients is Mary Fischer. Before the cardiac arrest, she had no idea that her heart was in danger, chalking the few episodes of chest pain she’d had up to anxiety. She is now back home, back at work, and doing everything but mowing her steep hillside. Her first grandchild is due to be born in January.
“I can’t thank everybody enough,” she said during a news conference at AGH earlier this month.
When the city of Pittsburgh arrived at Fischer’s house and couldn’t immediately restart her heart, they realized she would be a good candidate for ECPR. But not everyone qualifies.
To receive ECPR, patients must have had someone witness their cardiac arrest, and have a bystander begin CPR. At least three initial attempts to shock the heart back into rhythm must be unsuccessful. Patients also must be between 18 and 65 and have been able to live independently in good functional status before the cardiac arrest, with no prior neurocognitive or irreversible organ dysfunction.
Patients also must meet geographical requirements to be able to make it to an ECMO-capable emergency department within 45 minutes.
For that reason, AGH is currently partnering only with the city of Pittsburgh, Shaler and Ross EMS teams. They are hoping potentially to be able to expand it to other North Hills agencies as they work out the timing.
“It’s really difficult to thread the needle to make this process work,” said Mark Pinchalk, assistant chief of the city of Pittsburgh EMS. “But when we do, we have these great outcomes, which makes it all worthwhile.”
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