A qualitative analysis of physician decision making in the use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest

Tonna, Joseph E.; Keenan, Heather T.; Weir, Charlene R.

doi:10.1016/j.resplu.2022.100278

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…However, in this context, such trials are difficult to conduct for two main reasons. First, high‐volume cardiac arrest centers routinely providing extracorporeal CPR would consider it unethical to preclude this intervention for half of the enrolled patients 36,37 . Second, an extracorporeal CPR strategy that is high performing and effective in one center or system is not necessarily as effective and performant in another.…”

Section: Discussionmentioning

confidence: 99%

Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials

et al. 2023

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Background:In adults with refractory out-of-hospital cardiac arrest, when conventional cardiopulmonary resuscitation (CPR) alone does not achieve return of spontaneous circulation, extracorporeal CPR is attempted to restore perfusion and improve outcomes. Considering the contrasting findings of recent studies, we conducted a meta-analysis of randomized controlled trials to ascertain the effect of extracorporeal CPR on survival and neurological outcome. Methods: Pubmed via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched up to February 3, 2023, for randomized controlled trials comparing extracorporeal CPR versus conventional CPR in adults with refractory out-of-hospital cardiac arrest. Survival with a favorable neurological outcome at the longest follow-up available was the primary outcome. Results: Among four randomized controlled trials included, extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome at the longest follow-up available for all rhythms (59/220 [27%] vs. 39/213 [18%]; OR = 1.72; 95% CI, 1.09-2.70; p = 0.02; I 2 = 26%; number needed to treat of 9), for initial shockable rhythms only (55/164 [34%] vs. 38/165 [23%]; OR = 1.90; 95% CI, 1.16-3.13; p = 0.01; I 2 = 23%; number needed to treat of 7), and at hospital discharge or 30 days (55/220 [25%] vs. 34/212 [16%]; OR = 1.82; 95% CI, 1.13-2.92; p = 0.01; I 2 = 0.0%). Overall survival at the longest follow-up available was similar (61/220 [25%] vs. 34/212 [16%]; OR = 1.82; 95% CI, 1.13-2.92; p = 0.59; I 2 = 58%).Conclusions: Extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome in adults with refractory out-ofhospital cardiac arrest, especially when the initial rhythm was shockable.

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Section: Discussionmentioning

confidence: 99%

Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials

et al. 2023

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“…For instance, the ARREST trial aimed to evaluate the efficacy of ECPR in a highly specific patient population with a small team of experienced cannulators at a single center. 31 influenced by the difficulty waiting for eventual neurologic outcomes, 23 it is worth noting that guidelines recommend neuroprognostication be delayed at least 72 h following cardiac arrest. 32…”

Section: Evidence Behind Ecprmentioning

confidence: 99%

“…Achieving sustained programmatic success in the application of ECPR, however, is extremely complex, relying on a multidisciplinary effort to minimize time spent in a low‐flow state 14,23 . From prehospital organization, 24,25 procedural expertise, 26 and postresuscitation management, 27 it is an intricate framework that demands meticulous attention to detail.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] In addition to stable and augmented perfusion, ECPR allows for the cessation of external chest compressions, which in turn decreases trauma, stress, and frequent interruptions. [18][19][20][21][22][23] TA B L E 1 Trial characteristics and outcomes. Achieving sustained programmatic success in the application of ECPR, however, is extremely complex, relying on a multidisciplinary effort to minimize time spent in a low-flow state.…”

Section: Introductionmentioning

confidence: 99%

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The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life‐saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.

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“…In addition, sample size should be adequate to detect a clinically important difference [44,57]. A major issue for future research in EPCR for OHCA may be the fact that some may question whether there is still clinical equipoise between CCPR and ECPR [55,58] which is a prerequisite to justify randomization in this field [59].…”

Section: Future Perspectivementioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest – current status

Suverein,

Maessen,

van de Poll

2023

Current Opinion in Critical Care

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Purpose of review Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging treatment for refractory cardiac arrest. In recent years, several randomized controlled trials have been published that aimed to address the efficacy and effectiveness of ECPR for out-of-hospital cardiac arrest (OHCA). Despite the lack of high-quality evidence concerning clinical effectiveness and cost-effectiveness, ECPR is increasingly implemented throughout the world. In this review, we aim to provide an overview of the current status of ECPR for OHCA. Recent findings Randomized controlled trials showed diverging results, largely due to differences in selection criteria and study design. Single-center studies, performed in centers with extraordinary expertise and dedication consistently achieve a low-flow time of around 60 min, but such achievements are rarely reproduced outside these centers. Strict patient selection can improve outcome but simultaneously limits the caseload. Preliminary data suggest that outcome may also be improved by avoiding hyperoxia postresuscitation. Summary The potential of ECPR to increase survival in selected patients in highly dedicated systems seems to be proven, the question remains whether ECPR for OHCA can be widely implemented successfully and can develop into a sustainable, commonplace resource-effective treatment.

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A qualitative analysis of physician decision making in the use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest

Cited by 9 publications

References 34 publications

Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials

Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest – current status

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