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

Abstract

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).

Successful Prehospital Extracorporeal Cardiopulmonary Resuscitation: A Comprehensive Case Report and Analysis of the Current Experience and Knowledge

“…This case outlines a unique and challenging scenario in which a female patient, experiencing a cardiac arrest, received prehospital implantation of ECMO support. It sheds light on several key aspects of prehospital ECMO use and postresuscitation care as other similar cases described in the current literature [1]. Our hospital deemed prehospital ECMO feasible based on meticulous inclusion and exclusion criteria outlined in Figure 3, defining specific goals and appropriate timeframes for this intervention.…”

“…The foundation of ECPR rests on the principles of venoarterial ECMO, facilitating oxygenation and maintaining systemic perfusion during refractory cardiac arrest scenarios. Over the years, seminal studies have shed light on the theoretical underpinnings and initial clinical applications of ECMO in cardiac arrest, emphasizing its role as a bridge to recovery in select patient cohorts [ 1 ]. Concurrently, smaller-scale trials have highlighted the feasibility and potential benefits of prehospital ECMO implementation, marking a pivotal shift in the paradigm of resuscitative strategies [ 2 ].…”

A Modern Diagnostic Procedure—The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians’ Daily Routine

“…This requires trainees to have access to skilled and willing supervisors or risk having them not follow through after the initial introductory ultrasound course [ 13 ]. The courses have eased the way to the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) in our department, as per the latest resuscitation guidelines—this translates to highly qualified and confident users of POCUS, but the aim must be the uniformisation of ultrasound use among physicians and not just for a highly qualified team [ 23 ].…”