Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program

Tonna, Joseph E.; Selzman, Craig H.; Mallin, Michael; Smith, Brigham; Youngquist, Scott T.; Koliopoulou, Antigone; Welt, Frederick G.P.; Stoddard, Kathleen; Nirula, Ram; Barton, Richard G.; Fair, James; Fang, James C.; McKellar, Stephen H.

doi:10.1016/j.annemergmed.2016.10.001

Cited by 40 publications

(37 citation statements)

References 19 publications

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“…VA ECMO has been used as a rescue strategy in EDs for patients with cardiac arrest unresponsive to CPR by standard guidelines 13 . VA ECMO as a bridge to arrhythmia quiescence in patients with ventricular tachycardia electrical storm has been documented in patients with other inherited arrhythmogenic conditions, and falls within recommendations for appropriate use 14 .…”

Section: Discussionmentioning

confidence: 99%

Emergency department extracorporeal membrane oxygenation as a rescue therapy for ventricular tachycardia electrical storm: a case report

et al. 2020

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Arrhythmogenic right ventricular cardiomyopathy is a cause of sudden cardiac death in often otherwise healthy young adults. Cardiac arrest following an unstable tachydysrhythmia may be the primary presenting symptom. Venous arterial extracorporeal life support via extracorporeal membrane oxygenation (VA ECMO) has been used as a rescue strategy in emergency departments (EDs) for patients with cardiac arrest unresponsive to conventional cardiopulmonary resuscitation. We present a case of a previously healthy 18‐year‐old male who presented to our emergency department with ECG features of arrhythmogenic right ventricular cardiomyopathy and subsequent pulseless polymorphic ventricular tachycardia refractory cardiac arrest, treated with ED‐initiated VA ECMO.

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Section: Discussionmentioning

confidence: 99%

Emergency department extracorporeal membrane oxygenation as a rescue therapy for ventricular tachycardia electrical storm: a case report

et al. 2020

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“…The ECPR program for OHCA began in June 2015, and targeted OHCA patients < 60 years of age, with witnessed arrest, initial shockable rhythm, bystander CPR and no significant known comorbidities, such as trauma, cancer, or organ failure, who had refractory cardiac arrest (no ROSC after ≥ 20 min of conventional advanced cardiac life support [17]. The decision is made based on initially reported criteria, whereas eventually confirmed patient characteristics may be different.…”

Section: Methodsmentioning

confidence: 99%

“…Components of treatment with ECPR in this cohort have been previously described [17], but include cannulation in the emergency department, coronary angiography with revascularization, targeted temperature management (36 °C) in the intensive care unit for 24 h, followed by controlled rewarming over 72 h.…”

Section: Ecpr Treatmentmentioning

confidence: 99%

Exploratory analysis of myocardial function after extracorporeal cardiopulmonary resuscitation vs conventional cardiopulmonary resuscitation

et al. 2020

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Objective: Ventricular unloading is associated with myocardial recovery. We sought to evaluate the association of extracorporeal cardiopulmonary resuscitation (ECPR) on myocardial function after cardiac arrest. We conducted a retrospective exploratory analysis, comparing ejection fraction (EF) after adult cardiac arrest, between ECPR and conventional CPR. Results: Among 1119 cases of cardiac arrest, 116 had an echocardiogram post-return of spontaneous circulation (ROSC) and were included. Thirty-eight patients had ≥ 2 echocardiograms. ECPR patients had differences in age, hypertension and chronic heart failure. ECPR patients had a lower EF post-ROSC (24% vs 45%; p < 0.01) and were more likely to undergo percutaneous coronary intervention (25% vs 3%; p < 0.01). In multivariate analysis, only ECPR use (β-coeff: 10.4 [95% CI 3.68-17.13]; p < 0.01) independently predicted improved myocardial function. In this exploratory study, EF after cardiac arrest may be more likely to improve among ECPR patients than CCPR patients. Our methodology should be replicated to confirm or refute the validity of our findings.

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“…Published patient selection criteria currently in use for ECPR were identified by literature review [4][5][6][7][8][9]. This list formed the basis of the modified Delphi survey, involving 13 local, regional, national, and international experts, including members representing pre-hospital care, emergency medicine, cardiology, intensive care medicine, cardiac surgery, anesthesia, and perfusion technology.…”

Section: Determination Of Local Ecpr Selection Criteriamentioning

confidence: 99%

How Feasible is Extracorporeal Cardiopulmonary Resuscitation in a Medium Urban Population Centre?

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Atkinson

Mekwan

et al. 2019

Cureus

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Background Patients suffering from out-of-hospital cardiac arrest (OHCA) experience poor survival and neurological outcomes, with rates remaining relatively unchanged despite advancements. Extracorporeal membrane oxygenation (ECMO), termed extracorporeal cardiopulmonary resuscitation (ECPR) in arrests, may offer improved outcomes. We developed local screening criteria for ECPR and then estimated the frequency of use by applying those criteria retrospectively to a cardiac arrest database. The purpose was to determine if an ECPR program is feasible in a medium urban population centre in Atlantic Canada.

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Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program

Cited by 40 publications

References 19 publications

Emergency department extracorporeal membrane oxygenation as a rescue therapy for ventricular tachycardia electrical storm: a case report

Emergency department extracorporeal membrane oxygenation as a rescue therapy for ventricular tachycardia electrical storm: a case report

Exploratory analysis of myocardial function after extracorporeal cardiopulmonary resuscitation vs conventional cardiopulmonary resuscitation

How Feasible is Extracorporeal Cardiopulmonary Resuscitation in a Medium Urban Population Centre?

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