ECMO in Cardiac Arrest: A Narrative Review of the Literature

Abstract

Cardiac arrest (CA) is a frequent cause of death and a major public health issue. To date, conventional cardiopulmonary resuscitation (CPR) is the only efficient method of resuscitation available that positively impacts prognosis. Extracorporeal membrane oxygenation (ECMO) is a complex and costly technique that requires technical expertise. It is not considered standard of care in all hospitals and should be applied only in high-volume facilities. ECMO combined with CPR is known as ECPR (extracorporeal cardiopulmonary resuscitation) and permits hemodynamic and respiratory stabilization of patients with CA refractory to conventional CPR. This technique allows the parallel treatment of the underlying etiology of CA while maintaining organ perfusion. However, current evidence does not support the routine use of ECPR in all patients with refractory CA. Therefore, an appropriate selection of patients who may benefit from this procedure is key. Reducing the duration of low blood flow by means of performing high-quality CPR and promoting access to ECPR, may improve the survival rate of the patients presenting with refractory CA. Indeed, patients who benefit from ECPR seem to carry better neurological outcomes. The aim of this present narrative review is to present the most recent literature available on ECPR and to clarify its potential therapeutic role, as well as to provide an in-depth explanation of equipment and its set up, the patient selection process, and the patient management post-ECPR.

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

“…We did not find significant association between the initial rhythm and survival, which differs from the notion that survival under ECPR is better in patients with an initial shockable rhythm [ 36 ]. This discrepancy most likely reflects the small sample size in our study.…”

Hyperoxia During Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest Is Associated With Severe Circulatory Failure and Increased Mortality

“…We did not nd signi cant association between the initial rhythm and survival, which differs from the notion that survival under ECPR is better in patients with an initial shockable rhythm (35). This discrepancy most likely re ects the small sample size in our study.…”

Immediate complete revascularization showed better outcome in out-of-hospital cardiac arrest survivors with left main or triple-vessel coronary diseases

“…It should be noticed that extracorporeal life support using the extracorporeal membrane oxygenation (ECMO) was performed for the half of the patients in the complete revascularization group. Despite the conflicting results of the use of ECMO in OHCA patients, the potential therapeutic role of ECMO that helps preserve organ perfusion might affect the better outcome in complete revascularization group 15 . Also, the possibility of unknown confounders affecting the decision of immediate CABG should be considered when interpreting our results.…”