Five-year Experience of Extracorporeal Life Support in Emergency Physicians

Abstract

Background This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. Methods We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. Results Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. Conclusions The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Time from arrest to extracorporeal cardiopulmonary resuscitation and survival after out‐of‐hospital cardiac arrest

“…The decision of ECPR, a location of procedure, methods of vascular access, and device type were determined by attending physicians at each centre. Age, comorbidity and initial rhythm can be used for inclusion criteria of ECPR, and specialised team for ECPR is operated in some centers …”

Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry

“…In 2020, 74 EDs conducted at least one extracorporeal life support (ECLS) intervention for OHCA patients (median [interquartile range] volume of ECLS for OHCA 4 (2)(3)(4)(5)(6). The decision to perform ECPR is determined by attending physicians at each centre, and eligibility criteria using age, comorbidities, and cardiac rhythm can be used according to the centre [20][21][22]. In most centres, ECPR is performed by thoracic surgeons or cardiologists rather than an emergency physician.…”

Pre-hospital extra-corporeal cardiopulmonary resuscitation

“…Surgical cut down may reduce the expected failure rate in the pre-hospital setting. Limb Ischaemia In-hospital limb ischaemia after insertion of VA-ECMO cannulae is reported in the range of 12–15% [ 31 , 52 ] and would be similar in the pre-hospital environment. The usual practice of inserting a retrograde distal limb perfusion cannula would be deferred until arrival at hospital.…”