St. Paul’s Hospital is a quaternary care cardiac referral centre located in Vancouver, B.C. The Heart Centre at St. Paul’s Hospital is a unique resource for the province of B.C., providing comprehensive cardiac care, including cardiac transplant and ventricular assist device support. The centre treats approximately 30-40 Veno-Arterial ECMO cases per year, and has an established history of providing ECPR services to in-hospital cardiac arrests since 2000.

In June of 2015 St. Paul’s Hospital approved the creation of a formal ECPR service for out-of-hospital cardiac arrest (OHCA) that went live on January 1, 2016– the first of its kind in Canada. It was recognized that a highly organized system, with close collaboration between prehospital and multiple in-hospital services, would be required to identify appropriate out-of-hospital cardiac arrest patients and implement ECPR in a time-frame that could lead to favourable neurological outcomes. With these goals a program was developed, with the mandate to improve the likelihood of neurologically intact survival among patients with sudden unexpected cardiac arrest that is refractory to standard therapies. Although ECPR for patients treated with this service is initiated in the Emergency Department, this is a close collaboration with Cardiac Surgery and Perfusion Services, Interventional Cardiology, Intensive Care, and Cardiac Anesthesiology.

A partnership was formed between BC Emergency Health Services (BCEHS), the sole provider of prehospital medical care in B.C., and the St. Paul’s Hospital ECPR Service. May 24, 2016 marked the start of a regional ECPR protocol in Vancouver and the north shore, in which the provision of ECPR was formally incorporated into the management algorithm for out-of-hospital cardiac arrest. For all eligible patients remaining in refractory arrest after initial failed on-scene resuscitative efforts the St. Paul’s Hospital ECPR protocol was activated, and the patient is transported to hospital for ECPR initiation upon hospital arrival. The OHCA ECPR protocol was place on-hold during COVID, and has not yet re-started given human resource considerations.