Potential Candidates for Emergency Department Initiated Extracorporeal Cardiopulmonary Resuscitation (ECPR) in a Canadian Institution

Gould, James B.; Goldstein, Judah; Travers, Andrew H.; Swain, Janel; Carter, Alix; Rollo, Derek; Mekwan, Jay; Atkinson, Paul; Kovács, George

doi:10.7759/cureus.29318

Cited by 5 publications

(6 citation statements)

References 27 publications

(33 reference statements)

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“…The ECPR eligibility rate in OHCA patients is comparable; around 10.2–10.9% [ 17 – 19 ]. However, Gould et al [ 27 ] showed a higher eligibility rate of 14.1%. In their study, only non-traumatic cardiac arrest patients were included, which might be a possible explanation.…”

Section: Discussionmentioning

confidence: 99%

Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study

Verdonschot,

Buissant des Amorie,

Koopman

et al. 2023

European Journal of Emergency Medicine

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Background and importance Sudden cardiac arrest has a high incidence and often leads to death. A treatment option that might improve the outcomes in refractory cardiac arrest is Extracorporeal Cardiopulmonary Resuscitation (ECPR). Objectives This study investigates the number of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients eligible to ECPR and identifies clinical characteristics that may help to identify which patients benefit the most from ECPR. Design, settings and participants A retrospective two-centre study was conducted in Rotterdam, the Netherlands. All IHCA and OHCA patients between 1 January 2017 and 1 January 2020 were screened for eligibility to ECPR. The primary outcome was the percentage of patients eligible to ECPR and patients treated with ECPR. The secondary outcome was the comparison of the clinical characteristics and outcomes of patients eligible to ECPR treated with conventional Cardiopulmonary Resuscitation (CCPR) vs. those of patients treated with ECPR. Main results Out of 1246 included patients, 412 were IHCA patients and 834 were OHCA patients. Of the IHCA patients, 41 (10.0%) were eligible to ECPR, of whom 20 (48.8%) patients were actually treated with ECPR. Of the OHCA patients, 83 (9.6%) were eligible to ECPR, of whom 23 (27.7%) were actually treated with ECPR. In the group IHCA patients eligible to ECPR, no statistically significant difference in survival was found between patients treated with CCPR and patients treated with ECPR (hospital survival 19.0% vs. 15.0% respectively, 4.0% survival difference 95% confidence interval −21.3 to 28.7%). In the group OHCA patients eligible to ECPR, no statistically significant difference in-hospital survival was found between patients treated with CCPR and patients treated with ECPR (13.3% vs. 21.7% respectively, 8.4% survival difference 95% confidence interval −30.3 to 10.2%). Conclusion This retrospective study shows that around 10% of cardiac arrest patients are eligible to ECPR. Less than half of these patients eligible to ECPR were actually treated with ECPR in both IHCA and OHCA.

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Section: Discussionmentioning

confidence: 99%

Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study

Verdonschot,

Buissant des Amorie,

Koopman

et al. 2023

European Journal of Emergency Medicine

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“…These start-up costs can render the overall cost per ECPR patient unaffordable, particularly given the rarity of suitable ECPR candidates [62][63][64][65]. Beyond economic aspects, what stands out as important is identifying evidence that leads to a standardization of ECPR approach, clear patient selection criteria, and appropriate timing [43,65,66] for its use in the emergency department [67][68][69] or in the prehospital setting [52,53,70,71]…”

Section: Discussionmentioning

confidence: 99%

The Beginning of an ECLS Center: First Successful ECPR in an Emergency Department in Romania—Case-Based Review

Nedelea

Manolescu

Ciumanghel

et al. 2023

JCM

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According to the latest international resuscitation guidelines, extracorporeal cardiopulmonary resuscitation (ECPR) involves the utilization of extracorporeal membrane oxygenation (ECMO) in specific patients experiencing cardiac arrest, and it can be considered in situations where standard cardiopulmonary resuscitation efforts fail if they have a potentially reversible underlying cause, among which we can also find hypothermia. In cases of cardiac arrest, both witnessed and unwitnessed, hypothermic patients have higher chances of survival and favorable neurological outcomes compared to normothermic patients. ECPR is a multifaceted procedure that requires a proficient team, specialized equipment, and comprehensive multidisciplinary support within a healthcare system. However, it also carries the risk of severe, life-threatening complications. With the increasing use of ECPR in recent years and the growing number of centers implementing this technique outside the intensive care units, significant uncertainties persist in both prehospital and emergency department (ED) settings. Proper organization is crucial for an ECPR program in emergency settings, especially given the challenges and complexities of these treatments, which were previously not commonly used in ED. Therefore, within a narrative review, we have incorporated the initial case of ECPR in an ED in Romania, featuring a successful resuscitation in the context of severe hypothermia (20 °C) and a favorable neurological outcome (CPC score of 1).

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“…However, the use of ECMO in cases of cardiac arrest, known as extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promising results in enhancing patient survival while preserving favorable neurological outcomes. 20 A Danish study revealed a substantial failure rate, with only a minority of patients undergoing ECPR treatment achieving successful outcomes. Factors contributing to the avoidance of ECPR encompass prolonged prehospital low-flow duration, metabolic abnormalities, and diminished end-tidal carbon dioxide (ETCO 2 ) levels.…”

Section: Selecting the Perfect Candidate For Extracorporeal Membrane ...mentioning

confidence: 99%

Is Extracorporeal Membrane Oxygenation a Panacea?

Karaoğlanoğlu,

Akgün

2024

The Eurasian Journal of Medicine

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Extracorporeal membrane oxygenation (ECMO) has emerged as a vital life-support technique in critical care medicine, providing temporary circulatory and/or respiratory support for patients with severe cardiac or respiratory failure unresponsive to conventional therapies. This review aims to outline the importance of ECMO and provide a comprehensive overview of its main applications. Two primary types of ECMO, veno-arterial extracorporeal membrane oxygenation and veno-venous extracorporeal membrane oxygenation, serve distinct functions in supporting patients with cardiac or pulmonary dysfunction, respectively. While ECMO offers life-saving potential, its utilization requires careful consideration due to its cost and resource-intensiveness. Thus, a comprehensive evaluation of an individual patient’s clinical condition, prognosis, and potential for recovery is crucial. Ongoing research and technological advancements continually refine ECMO techniques, enhance patient selection criteria, and improve long-term outcomes. Within this narrative review, we present an updated approach to patient selection and ECMO utilization, supported by a detailed literature review. By consolidating the current evidence, we aim to provide healthcare professionals with valuable insights into the ECMO’s post-pandemic role.

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Potential Candidates for Emergency Department Initiated Extracorporeal Cardiopulmonary Resuscitation (ECPR) in a Canadian Institution

Cited by 5 publications

References 27 publications

Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study

Eligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study

The Beginning of an ECLS Center: First Successful ECPR in an Emergency Department in Romania—Case-Based Review

Is Extracorporeal Membrane Oxygenation a Panacea?

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