REANIMATE
Rapid prehospital Extracorporeal cArdiopulmoNary resuscItation for Management of out-of-hospital cardiac ArresT
A phased research program to determine how best to integrate ECPR into cardiac arrest care in Canada, comparing prehospital vs in-hospital delivery strategies.
The Problem
Only 10% of out-of-hospital cardiac arrest patients survive, dropping to <1% for refractory cases. While ECPR can achieve 43% survival when initiated early, transport delays mean <10% of eligible patients reach ECPR within the critical 60-minute window. In Montreal, >75% of ECPR patients have 911-to-ECPR times exceeding 60 minutes, severely limiting the benefit of in-hospital ECPR.
Our Approach
A three-phase program: REANIMATE-0 is a 24-patient adaptive pre-pilot testing prehospital ECPR feasibility in Montreal-Laval with a traffic-light decision framework. REANIMATE-1 is a 76-patient internal pilot RCT comparing prehospital vs in-hospital ECPR using 24-hour period randomization. REANIMATE-2 will be a 532-patient definitive RCT. Our Monte Carlo simulations estimate prehospital ECPR could raise sub-60-minute flow recovery from 37% to 99.7%, shorten low-flow time by 7.8 minutes, and improve survival from 25.3% to 39.5%.
Innovation
First Canadian trial of prehospital ECPR, with novel mobile cannulation protocols developed in partnership with Urgences-santé. The adaptive design with traffic-light progression criteria (green/amber/red) ensures rigorous feasibility assessment before scaling. The prehospital team includes physicians already proficient in in-hospital ECPR, with specialized training from Dr. Lionel Lamhaut, an international pioneer in prehospital ECPR.
Project Timeline
- Yiorgos Alexandros Cavayas (PI)
- Lawrence Leroux (Co-PI)
- Alexis Cournoyer (Co-PI)
- Lionel Lamhaut (Co-PI)
- Brian Grunau (Co-I)
- Sheldon Cheskes (Co-I)
- Christian Vaillancourt (Co-I)
- Meilynn Schnitzer (Biostatistics)
- Urgences-santé EMS
- Hôpital Sacré-Cœur de Montréal
- McGill University Health Centre
Leroux L et al. Impact of prehospital ECPR on survival with good neurological function: systematic review & meta-analysis. Resuscitation Plus, 2025
Leroux L et al. Optimizing ECPR delivery for OHCA: a Monte Carlo simulation study. Resuscitation, 2025
Heart & Stroke Foundation - REANIMATE-0 (pending)
CIHR - REANIMATE-1 (pending)