EDECMO 108: On Scene Trial

In this groundbreaking EDECMO episode, Dr. Dinis Miranda joins Zack Shinar and John Marinaro to discuss the ON-SCENE trial, which demonstrated a dramatic improvement in cardiac arrest outcomes using prehospital ECPR. By equipping the Netherlands’ existing helicopter emergency medical services with ECMO capabilities, the team achieved 40% survival to hospital discharge compared with 20% in the conventional care group, with favorable neurological outcomes of 36% versus 13%. Remarkably, physicians with little or no prior ECMO experience were trained through intensive simulation to perform field cannulation, achieving ECMO flow in an average of just 45 minutes from arrest. The discussion explores the importance of rapid reperfusion, standardized protocols, remote ECMO expertise, and the potential advantages of bringing ECMO to the patient rather than transporting the patient to ECMO. The ONSCENE trial challenges traditional ECPR systems and offers a compelling vision for the future of resuscitation: build the system around the patient, not the patient around the system.