Fig. 2

ECPR scenarios and distance of OHCA to the ECPR center. Potential scenarios for implementation of extracorporeal resuscitation (ECPR) in relation to the proximity of the place of out-of hospital cardiac arrest (OHCA) the ECPR center. Main aim is to minimize low-flow time. In the 'load and go' scenario, OHCA occurs in close proximity to the ECPR center. The victim is rapidly transported as soon as ECPR is designated as the treatment goal while the ECPR team assembles. The ‘on-site cannulation’ may save time when there is a significant expected transportation time. The ECPR team is alerted when an OHCA patient who qualifies for ECPR is identified and the team is transported to the site as quickly as possible. Although there is no transportation time until cannulation, the cannulation process itself may be challenging due to the unusual conditions. In more remote areas, a ‘rendezvous at initiation hospitals’, following the 'Minnesota model [107]', may be the optimal choice. Patients and the ECPR team convene at these dedicated hospitals, staffed with trained personnel. In all scenarios, it is theoretically possible to achieve ECPR cannulation and extracorporeal membrane oxygenation (ECMO) flow within a low-flow time of less than 60 min. Times given in this figure are estimates and not derived from clinical trials