A novel extracorporeal cardiopulmonary resuscitation strategy using a hybrid emergency room for patients with pulseless electrical activity

Abstract

Background Whether extracorporeal cardiopulmonary resuscitation (ECPR) is indicated for patients with pulseless electrical activity (PEA) remains unclear. Pulmonary embolism with PEA is a good candidate for ECPR; however, PEA can sometimes include an aortic disease and intracranial haemorrhage, with extremely poor neurological outcomes, and can thus not be used as a suitable candidate. We began employing an ECPR strategy that utilised a hybrid emergency room (ER) to perform computed tomography (CT) before extracorporeal membrane oxygenation (ECMO) induction from January 2020. Therefore, the present study aimed to evaluate the effectiveness of this ECPR strategy. Methods Medical records of patients who transferred to our hybrid ER and required ECPR for PEA between January 2020 and November 2021 were reviewed. Results Twelve consecutive patients (median age, 67 [range, 57–73] years) with PEA requiring ECPR were identified in our hybrid ER. Among these patients, nine were diagnosed using an initial CT scan (intracranial haemorrhage (3); cardiac tamponade due to aortic dissection (3); aortic rupture (2); and cardiac rupture (1)), and unnecessary ECMO was avoided. The remaining three patients underwent ECPR, and two of them survived with favourable neurological outcomes. Patients not indicated for ECPR were excluded before ECMO induction. Conclusion Our ECPR strategy that involved the utilisation of a hybrid ER may be useful for the exclusion of patients with PEA not indicated for ECPR and decision making.

Novel and innovative resuscitation systems in Japan

“…6 ). 14 , 44 , 45 , 46 When critically ill patients arrive at the hospital, they are immediately transferred from the ambulance to the hybrid ER. Diagnostic procedures, such as radiography and CT, were performed immediately, and catheter interventions or surgical procedures were initiated in the same place, if needed, without any transfer to other beds or facilities.…”

“…The hybrid ER also has great potential for cardiac arrest management, particularly for patients for whom ECPR is considered. 45 , 50 We identified two primary strengths in maximizing the effectiveness of the ECPR strategy. Because the hybrid ER facilitates fluoroscopy for angiography, it is expected to contribute to safe cannulation and shorten the time to implement ECPR.…”

“…In this strategy, CT is performed immediately before ECPR initiation in patients suspected of having non-cardiac causes, such as OHCA patients with an initial non-shockable rhythm. 45 During the scanning, mechanical CPR is continuously employed to avoid interruptions. To shorten the scanning time, head and chest CT scans were performed immediately without scanning scout images.…”

Venoarterial extracorporeal membrane oxygenation for cardiopulmonary resuscitation: A retrospective study comparing the outcomes of fluoroscopy

“…Efforts to achieve safer and more efficient introduction of VA-ECMO for cardiopulmonary arrest have led to the exploration of fluoroscopic facilities in emergency rooms (hybrid ER) for ECPR [ [13] , [14] , [15] ]. Nevertheless, not all facilities have immediate access to fluoroscopic equipment, which may necessitate catheterization under non-fluoroscopic conditions during ECPR [ 16 ].…”

Treatment strategy for severe trauma patients requiring aortic occlusion for impending cardiopulmonary arrest in the hybrid emergency room

“…Hybrid ER use has also allowed safe and prompt initiation of other procedures such as extracorporeal membrane oxygenation for internal diseases such as massive pulmonary embolism. 5 , 6 …”