The Trial
Sudden Cardiac Arrest
Sudden cardiac arrest is one of the leading causes of death in otherwise healthy adults, affecting approximately 25,000 Australians each year. For those who suffer an out-of-hospital cardiac arrest (OHCA), survival rates remain low, with death occurring in 87–94% of cases. Despite ongoing advances in emergency response systems, improving survival from OHCA remains one of the most urgent challenges in modern medicine.
What Is ECPR?
ECPR is the combination of CPR and an extracorporeal membrane oxygenation machine (ECMO) during cardiac arrest.
In simple terms, it is a form of temporary heart and lung bypass. While the heart is not beating effectively, a machine circulates oxygenated blood throughout the body, supplying the brain, heart, and other vital organs. ECPR essentially “stops the clock,” buying critical time to allow time to treat the underlying cause of the arrest and restore circulation.
When cardiac arrest occurs the circulation can be described as a ‘no-flow state’ or ‘low-flow state’
No-flow is when no CPR is being performed, and there is no blood circulation, low-flow state is when CPR is underway, but blood flow is significantly reduced compared to normal circulation.
Although high-quality CPR is lifesaving, it delivers only a fraction of normal cardiac output, and this flow declines over time. Adequate oxygenated blood flow is essential to protect the brain and heart. ECPR provides near-normal blood flow during cardiac arrest, dramatically improving organ perfusion while definitive treatment is delivered.
While ECPR is increasing in the hospital setting, pre-hospital ECPR has only been implemented in test scenarios in a handful of cities world-wide. One of the reasons for this is pre-hospital ECPR is often perceived as expensive. However, PRECARE’s research has shown, when compared directly to other critical interventions, it behaves economically like a mainstream acute intervention.
Evidence Behind ECPR
ECPR has been used in hospital settings for many years. In patients with refractory ventricular fibrillation (VF) where standard resuscitation fails, survival rates current sit at less than 5%, initial research shows PRECARE is changing that.
One of the strongest predictors of outcome is time, the shorter the duration of cardiac arrest before ECPR is established, the better the survival and neurological outcome. Careful patient selection and rapid initiation are key determinants of success.
A Team-Based Approach to Resuscitation
ECPR does not replace high-quality CPR, like all cardiac arrest, it requires it. Immediate bystander CPR and excellent advanced life support (ALS) remain the foundation of survival. ECPR is an adjunct therapy delivered within a highly coordinated system of care. The specialist PRECARE team bring advanced, traditionally hospital-based interventions directly to the patient in the pre-hospital setting. These interventions enhance, not replace, paramedic resuscitation efforts.
Personalised Resuscitation
While oxygenation and perfusion are fundamental to cardiac arrest management, we know that cardiac arrest is not a single uniform condition, different patients exhibit different physiological patterns during arrest.
To improve survival, resuscitation must evolve toward personalised, haemodynamic-directed CPR. By tailoring resuscitation to the individual, we can move beyond a one-size-fits-all model and improve meaningful survival of OHCA in Australia.
What is the cost of the trial and how is it funded?
The cost of consumables to perform ECPR are approximately $10,000 per patient. This does not include a patient’s hospital stay. None of the PRECARE associated costs are passed on to the patient. During the trial PRECARE have conducted studies and analysis on the ongoing costs of pre-hospital ECPR, with promising results. The current trial is sponsored by NSW Ambulance and supported with in-kind support by Westmead Hospital and RPA Hospital. The trial is also supported by GE Healthcare, Australian Blood Management. The trial received a Greenlight Foundation research grant and a NSW Health research grant. Funding for the PRECARE trial program currently runs until June 2026, it’s future after this is uncertain.
PRECARE 