Extracorporeal life support

Abstract

Purpose of review: Refractory cardiac arrest still has a grave prognosis under conventional cardiopulmonary resuscitation (CPR). We present the recent studies in extracorporeal CPR (ECPR) for the treatment of refractory cardiac arrest.

Recent findings: Apart from the studies of ECPR in pediatric in-hospital cardiac arrest (IHCA), there was an increasing number of studies of this therapy in adult IHCA and out-of-hospital cardiac arrest (OHCA). The indications for ECPR varied across studies. In most cases ECPR was deployed on patients with reversible cardiac diseases or other cardiac diseases such as congenital heart disease, postcardiotomy arrest or acute myocardial infarction. Higher lactate values, longer CPR duration and postresuscitation renal failure were associated with increasing mortality. Percutaneous coronary intervention and therapeutic hypothermia were increasingly used along with ECPR.

Summary: In this review, survival after ECPR was generally best after pediatric IHCA (38-57%), followed by adult IHCA (34-46%) and then adult OHCA (4-36%). Most studies reported that longer conventional CPR duration was associated with mortality after ECPR; however, there was no consensus on the optimal conventional CPR duration before ECPR initiation. Future studies might focus on the indications for ECPR, which should maximize the survival potential after ECPR while reducing the overuse of this resource-intensive facility.