Cleveland-based University Hospitals launched its first extracorporeal cardiopulmonary resuscitation program at a community hospital.
The program launched in November 2025 and is housed in the UH Harrington Heart & Vascular Institute at University Hospitals Elyria (Ohio) Medical Center, a level 3 trauma center. So far, there have been four cannulations for out of hospital cardiac arrest, with one patient achieving neuro intact survival and walking out of the hospital, Colin McCloskey, MD, an emergency medicine physician and anesthesiologist at University Hospitals Harrington Heart & Vascular Institute at UH Elyria Medical Center, told Becker’s.
ECPRs are typically limited to large academic medical centers due to the complexity of the procedure.
“We are the first hospital in Ohio to regionalize this system of care, so now folks in both Cuyahoga and Lorain counties in Northeast Ohio have access,” Dr. McCloskey said. “ECPR, when implemented thoughtfully, is a revenue-generating procedure for the hospital.”
Dr. McCloskey and Elizabeth Streby, MD, chief medical officer of University Hospitals Elyria Medical Center, discussed the strategy that went into bringing ECPR to rural communities.
Question: What was the strategic thinking behind moving ECPR into a community hospital?
Dr. Colin McCloskey: Cardiac arrests happen everywhere, not just within the catchment area of academic medical centers. Most ECPR programs to date originate at academic medical centers due to the coalesced resources at those settings. Our group wanted to expand this system of care to a greater proportion of the population we serve in Northeast Ohio, and to scale it in a way that would be repeatable at our regional sites.
Dr. Elizabeth Streby: We have a large, high acuity ED and a high volume cardiac cath lab. Sadly, we see a lot of cardiac arrests come through our hospital. When University Hospitals Harrington Heart & Vascular Institute leadership approached us about the possibility of ECPR at UH Elyria Medical Center, I knew we could do it and we had all the right components at our hospital to make it happen. As a CMO and emergency medicine physician, I understand the resources needed for this ambitious endeavor and have the operational connectedness with all of the stakeholders to make this happen.
Q: What were some of the barriers that make ECPR tricky to implement outside of an academic medical center?
CM: ECPR at our regional sites involves prehospital recognition/transport, ED coordination of patient flow, ECMO device readiness and cannulation in the cath lab, then interfacility transport of a sick patient. Each of these steps has to be identified, trained/simulated, and then iterated with experience. It is a large upfront training effort and a commitment to ongoing evolution after the program goes live.
ES: ECPR is a complex procedure with strict inclusion criteria. The procedure itself requires highly trained individuals, but equally important, it requires a huge team of people to do all the right things to get the patient to the procedure, support the patient through the procedure, then deliver the patient safely and efficiently to a quaternary medical facility. This required a lot of boundary spanning leadership, attention to design with each stakeholder team, detailed process mapping and disciplined simulation before we were ready to go live. We had to see this process through the wide angle lens and the microscopic lens.
Q: What workflows are required to maintain a successful program?
CM: A viable ECPR program requires collaboration between prehospital, emergency medicine, interventional cardiology, perfusion services, critical care, respiratory therapy, pharmacy, and critical care transport just to get patients cannulated and transferred to our academic center. There, we leverage expertise of our CTICU physicians, heart failure cardiologists, cardiothoracic surgeons, palliative care, and physical therapy to achieve durable long-term outcomes. It is a lot of work! Further, the lift is continuous: Initial training needs to marry with ongoing quality improvement and maintenance of competency through schedule simulations. It is quite the commitment, though worth it for our patients and the system at large.
ES: We have local management of our process and workflows, it is a collaborative between us at the local level and the system team. As a community hospital, we have different personnel than what is available at the main campus. We trained people to do tasks that would be done by others at a large academic medical center. For example, we have a team of ICU nurses who are trained to assist with the pump initiation and management until a perfusionist arrives at our facility. Another example, our nursing supervisor acts as “air traffic control” during the whole process. We had to develop those workflows and they look very different from what occurs at the main campus. With any complex process that requires high level performance of its teams, we continuously debrief and simulate.
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