Extracorporeal Cardiopulmonary Resuscitation

Abstract

ECMO, or extracorporeal membrane oxygenation, is an advanced life support technique that provides cardiac and pulmonary support similar to cardiopulmonary bypass. ECPR (extracorporeal cardiopulmonary resuscitation) is the rapid deployment of VA-ECMO when conventional cardiopulmonary resuscitation fails to provide return of spontaneous circulation. Evidence in the literature is sparse, but with expanding reported applications, ECPR has shown promise to improve outcomes of cardiac arrest. ECPR is superior to conventional CPR for both survival and neurologic outcomes. ECPR has been successfully used to manage arrests secondary to cardiac and non-cardiac causes. Arrests secondary to primary cardiac causes have the best overall outcome. Other determinants of outcomes of ECPR include duration of low flow state and on-ECMO complications. A narrow list of ECPR contraindications exists, and includes severe neurologic injury and irreversible primary disease process. Various complications can occur with ECPR, and include mechanical, cardiovascular, pulmonary, hematologic, renal, and neurologic complications. Neurologic complications are the most serious, and significantly affect mortality or quality of life. ECPR is a nascent field, and substantial work remains to be done to optimize its application. Given the small number of patients at each institutional level, this is a field ripe for collaborative work and rewarding results.

Predictors of survival for pediatric extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis

“…Variability in survival outcomes and limited data on associated risks including severe neurological, renal, and cardiac complications have led to a lack of consensus on implementation guidelines and patient selection. [ 7 , 11 – 13 ] These factors place the decision to cannulate onto the provider’s clinical judgement.…”

“…[1][2][3] The adoption of extracorporeal membrane oxygenation (ECMO) since 1976 has greatly increased survival rates for this patient population. [4][5][6][7] The use of ECMO for cardiopulmonary resuscitation (ECPR) has been increasing rapidly in pediatric and adult populations. [8,9] This variability, coupled with rapidly improving technological developments and increased adoption of ECPR within the last 10 years, has made a meta-analysis covering the most recent literature a necessity.…”

“…[1–3] The adoption of extracorporeal membrane oxygenation (ECMO) since 1976 has greatly increased survival rates for this patient population. [4–7]…”