What is extracorporeal cardiopulmonary resuscitation?

Pappalardo, Federico; Montisci, Andrea

doi:10.21037/jtd.2017.05.33

Cited by 27 publications

(22 citation statements)

References 43 publications

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“…Many factors could account for this outcome variation including heterogeneity of health systems, populations, interventions and follow up . While ECPR is promising, appropriate patient selection, optimal timing and cost‐effectiveness remain uncertain; although a shorter ‘low‐flow’ time, the CPR duration before ECPR initiation has been found to be associated with survival and positive neurological outcomes . While prehospital ECPR has been found to be feasible, safe and effective, it has yet to show a survival advantage over hospital initiated ECPR for OOHCA, despite being associated with significantly increased rates of return of spontaneous circulation (ROSC) and shorter periods of circulatory low‐flow …”

Section: Introductionmentioning

confidence: 99%

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Kilner

Stanton

Mazur

2019

Emerg Medicine Australasia

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Objective:We sought to identify out-of-hospital cardiac arrest (OOHCA) patients who might benefit from a future prehospital extracorporeal cardiopulmonary resuscitation (ECPR) programme in a moderately sized city. We described the 2014 OOHCA data and identified those who fulfilled hypothetical prehospital ECPR eligibility criteria. Methods: We identified patients aged 18-65 years in cardiac arrest, where CPR was commenced by paramedics on arrival. Traumatic cardiac arrest and end-of-life needs were patient exclusions. Patients were then included in one of three hypothetical 'ECPR eligible' groups. Patients were included in an 'ECPR eligible' group if they met author agreed criteria. Select patients in refractory VT/VF; pulseless electrical activity (PEA); and non-refractory VT/VF, or asystole with subsequent VT/VF or transient return of spontaneous circulation (ROSC), were assigned to three separate groups. Descriptive statistics were applied to each group. Outcomes of ECPR eligible patients who developed sustained ROSC after 20 min of conventional CPR were characterised. Results: A total of 206 patients were included. A significant positive association between initial shockable rhythm (odds ratio [OR] 15.32, confidence interval [CI] 5.4-43.2) and sustained ROSC, and PEA (OR 6.93, CI 2.4-19.8) and sustained ROSC, versus asystole was identified (P < 0.001). Sixty-eight (33%) patients were eligible for one of the hypothetical ECPR groups. Twelve (17.6%) of the 68 ECPR eligible patients developed sustained ROSC after 20 min of conventional CPR, with only two surviving neurologically intact to hospital discharge. Conclusion: Sixty-three (30.6%) patients could have derived benefit from a prehospital ECPR programme. Further analyses of prehospital ECPR logistics and economics are necessary to ensure that any future prehospital ECPR programme is effective and efficient.

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Section: Introductionmentioning

confidence: 99%

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Kilner

Stanton

Mazur

2019

Emerg Medicine Australasia

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“…In general, extracorporeal CPR refers to the implantation of veno‐arterial ECMO (VA‐ECMO) for cardiopulmonary support in patients who have experienced a sudden and unexpected pulseless condition attributable to cessation of cardiac mechanical activity. However, many aspects of ECMO remain uncertain; for example, a clear indication or univocal definition of extracorporeal CPR is lacking and, in some cases, extracorporeal CPR may be more than VA‐ECMO implantation on a patient in cardiac arrest . In cases where return of spontaneous circulation cannot be sustained due to profound respiratory failure, CPR with the assistance of veno‐venous ECMO (VV‐ECMO) for pulmonary resuscitation may also be broadly considered as extracorporeal CPR.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in refractory intra‐operative cardiac arrest: an observational study of 12‐year outcomes in a single tertiary hospital

et al. 2018

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Refractory intra-operative cardiac arrest is a challenging issue for anaesthetists. In this study, we analysed the outcomes of adult patients who received extracorporeal cardiopulmonary resuscitation for refractory intraoperative cardiac arrest between 2005 and 2016, using data from our institutional extracorporeal membrane oxygenation registry. We defined refractory intra-operative cardiac arrest as the failure of a return of spontaneous circulation after 30 min of cardiopulmonary resuscitation. The primary outcome measure was neurologically intact survival with a cerebral performance category score of 1 or 2 at hospital discharge. Between 2005 and 2016, extracorporeal cardiopulmonary resuscitation was used to treat 23 patients who experienced refractory cardiac arrest in the operating room. The survival rates of neurologically-intact subjects were 9/23 (39%) and 6/23 (26%) at 24 h postoperatively and at hospital discharge, respectively. The main cause of refractory-intra-operative cardiac arrest was haemorrhagic shock in 13 out of 23 (57%) patients, and the neurologically-intact survival rate in these patients was 3/13 (23%) at discharge. Our study showed that approximately a quarter of patients with refractory intra-operative cardiac arrest caused by haemorrhage would receive survival benefit from extracorporeal cardiopulmonary resuscitation. Therefore, extracorporeal cardiopulmonary resuscitation may be a possible option in this clinically-challenging situation.

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“…ECPR use for victims of cardiac arrest consistently demonstrates a survival benefit over conventional CPR [5][6][7][8]. This survival benefit is more pronounced as the duration of CPR increases.…”

Section: Ecpr Is Superior To Conventional Cprmentioning

confidence: 92%

“…ELSO recognizes that ECMO can be considered for select patients in cardiac arrest. In 2015, the American Heart Association (AHA) cautiously pointed out that while the evidence is still lacking, ECPR may reasonably be considered in potentially reversible situations [5].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation

Farhat¹,

Bowens²,

Thiagarajan³

et al. 2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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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.

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What is extracorporeal cardiopulmonary resuscitation?

Cited by 27 publications

References 43 publications

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Prehospital extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A retrospective eligibility study

Extracorporeal cardiopulmonary resuscitation in refractory intra‐operative cardiac arrest: an observational study of 12‐year outcomes in a single tertiary hospital

Extracorporeal Cardiopulmonary Resuscitation

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