Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR): consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC

Michels, Guido; Wengenmayer, Tobias; Hagl, Christian; Dohmen, Christian; Böttiger, Bernd W.; Bauersachs, Johann; Markewitz, Andreas; Bauer, Adrian; Gräsner, Jan–Thorsten; Pfister, Roman; Ghanem, Alexander; Busch, Hans-Jörg; Kreimeier, U.; Beckmann, Andreas; Fischer, Matthias; Kill, Clemens; Janssens, Uwe; Kluge, Stefan; Born, F.; Hoffmeister, Hans Martin; Preusch, Michael; Boeken, Udo; Riessen, Reimer; Thiele, Holger

doi:10.1007/s00392-018-1366-4

Cited by 94 publications

(82 citation statements)

References 75 publications

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“…To date, there has been a lack of RCTs of ECPR and there are no prospectively validated criteria for EC- PR indications or patient selection. However, favorable outcome can be expected with ECPR when employed for cardiac arrest under several conditions (Table 2) [23,24]. In the real world, ECPR is commonly performed and quite useful in the cardiac surgical ICU, medical cardiac ICU, and cardiac catheterization laboratory.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Role of extracorporeal cardiopulmonary resuscitation in adults

Kim

Cho

2020

Acute Crit Care

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Role of extracorporeal cardiopulmonary resuscitation in adults Extracorporeal cardiopulmonary resuscitation (ECPR) has been performed with increasing frequency worldwide to improve the low survival rate of conventional cardiopulmonary resuscitation (CCPR). Several studies have shown that among patients who experience in-hospital cardiac arrest, better survival outcomes and neurological outcomes can be expected after ECPR than after CCPR. However, studies have not clearly shown a short-term survival benefit of ECPR for patients who experience out-of-hospital cardiac arrest. Favorable outcomes are associated with a shorter low-flow time, an initial shockable rhythm, lower serum lactate levels, higher blood pH, and a lower Sequential Organ Failure Assessment score. Indications for ECPR include young age, witnessed arrest with bystander cardiopulmonary resuscitation, an initial shockable rhythm, correctable causes such as a cardiac etiology, and no return of spontaneous circulation within 10-20 minutes of CCPR. ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system, and it has the risk of several life-threatening complications. Therefore, physicians should carefully select patients for ECPR who can gain the most benefit, instead of applying ECPR indiscriminately.

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Section: Indications and Contraindicationsmentioning

confidence: 99%

Role of extracorporeal cardiopulmonary resuscitation in adults

Kim

Cho

2020

Acute Crit Care

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“…See Table 13 for a summary of available published criteria for ECPR. 80,82 Age continues to be a controversial criterion. The American Heart Association states that there is insufficient evidence to recommend the routine use of ECPR.…”

Section: Trends In Va-ecmo Usementioning

confidence: 99%

“…Consultation and patient selection are critical parts of the program. 64,82,83 Organizational requirements, ECPR recommendations, and algorithms have been published. 80,82 Through initial experiences by mobile ECMO teams, data are emerging on the profile of patients who will benefit more from mobile ECMO: younger patients (<60 years); patients with no flow time of fewer than 5 minutes; and patients with a shockable rhythm, sufficient CPR, and ECMO implantation time of 60 minutes.…”

Section: Trends In Va-ecmo Usementioning

confidence: 99%

“…64,82,83 Organizational requirements, ECPR recommendations, and algorithms have been published. 80,82 Through initial experiences by mobile ECMO teams, data are emerging on the profile of patients who will benefit more from mobile ECMO: younger patients (<60 years); patients with no flow time of fewer than 5 minutes; and patients with a shockable rhythm, sufficient CPR, and ECMO implantation time of 60 minutes. 82,84 There are also case reports and reviews describing the use of ECMO for temporary circulatory support during procedures such as ventricular tachycardia ablation, percutaneous valve replacement, and resection of a thoracic mass.…”

Section: Trends In Va-ecmo Usementioning

confidence: 99%

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Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Kwak

Majewski

Jellish

2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…In selected cases, however, transporting the patient still in cardiac arrest to a hospital for causal treatment of a potentially reversible cause of cardiac arrest is warranted [1,2]. Some EMS-systems prefer establishing extracorporeal cardiopulmonary resuscitation (eCPR) by implanting a veno-arterial extracorporeal membrane oxygenation (ECMO) on scene [3], whereas other concepts recommend transporting the patient to the hospital under ongoing CPR and establishing ECMO in-hospital [1]. Performing high-quality CPR during transport (consisting of evacuation from the scene to the ambulance, drive to the hospital, and transfer to treatment facility therein) can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

Drinhaus

Nüsgen²,

Adams

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: If transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto. We aimed to elaborate a strategy for evacuation of patients under ongoing CPR from an upper floor, comparing three different evacuation routes and manual and mechanical chest compressions. Methods: A CPR-training manikin recording CPR-quality was placed on the fifth floor and was evacuated to an ambulance via lift, turntable ladder, or staircase. Chest compressions were performed manually or with a mechanical CPR-device. Efficiency endpoints were compression depth and frequency, sufficiency of chest release, compared with European Resuscitation Council (ERC) Guidelines, and duration of the evacuation. Adverse outcomes were disconnection/dislocation of devices and hazards/accidents to the personnel.Results: For all evacuation routes, compression depth and frequency were significantly more compliant with ERCguidelines under mechanical CPR. Manual CPR was associated with considerable deviations from correct compression depth and frequency. Chest release only slightly differed between groups. Evacuation via lift under mechanical CPR was fastest and evacuation via turntable ladder under manual CPR was slowest. No device disconnections or accidents occurred, but hazard to personnel was perceived during evacuation via ladder under manual CPR. Conclusions:In this study, a mechanical CPR-device proved to deliver better CPR-quality during evacuation from an upper floor. If a lift accessible with a stretcher is available, this route should be preferred, regardless of manual or mechanical CPR. Turntable ladders can only be meaningfully used with mechanical CPR, otherwise CPR-quality is poor and hazard to the personnel is increased. Not all evacuation routes may be useable in a specific real-life scenario.

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Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR): consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC

Cited by 94 publications

References 75 publications

Role of extracorporeal cardiopulmonary resuscitation in adults

Role of extracorporeal cardiopulmonary resuscitation in adults

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

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