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There is no obvious timeframe which is “too early,” but patients already at ECMO-ready centers might reasonably wait longer to go on bypass, as it can be done quickly and safely when necessary without requiring interfacilitytransport.* Anticoagulate most patients on VV ECMO with heparin to a PTT of 45-55.
The decisions referring providers make regarding emergency medical services (EMS) level of care and transport modality (ground versus air) can dramatically impact patient care, emergency departments' workflow, hospital length of stay, and EMS resource availability.
Whether your program is primarily 9-1-1, interfacilitytransport (IFT), or a combination of both, the likelihood of being responsible for the safe and expeditious transport of a STEMI patient is high for anyone in the out-of-hospital care setting. An angiogram is performed to confirm the wire is in the common iliac.
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