Table 3 Key recommendations for implementing an ECPR system for OHCA

Prioritise education and awareness of relevant ambulance services, including justification for ECPR. Allow time and utilise a variety of dissemination methods

Perform regular high-fidelity simulations with all teams involved (pre-hospital, ECPR, resuscitation), focusing on technical aspects and human factors, and learn from them

Learn from every case. Aim to identify any and all system-specific barriers and implement systems to overcome these where feasible

Empower critical care specialists to adapt management of patients as they see appropriate for a given situation (mission command)

Utilise critical care specialists at the operations centre to support teams and advise ambulance crews

Employ a simple pre-alert, without need to seek acceptance. This could include a direct escalation via switchboard, and a short clinical conversation with on-call consultant to aid decisions whether to open sterile equipment

Standardise handover in terms of information given and develop a hospital culture to be engaged and listen only once, within the cardiac catheter lab

Develop clear, unambiguous patient inclusion criteria. Consider the information present and reassess when new information presents

Protocolise, simplify and adapt every process including escalation, the technical procedure, and the equipment used

Establish clear team roles including a non-cannulating scene leader responsible for protocol adherence

Read the protocol aloud to the hospital cannulating team

Train as small a team as possible to feasibly staff the hospital system to facilitate maximal exposure to technical procedures

Ensure psychological support is available to team members. ‘Hot’ debrief where possible and allow time before returning to duties