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Review
. 2020 Apr 7;9(7):e015291.
doi: 10.1161/JAHA.119.015291. Epub 2020 Mar 24.

Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Adult Patients

Akihiko Inoue  1   2 , Toru Hifumi  3 , Tetsuya Sakamoto  4 , Yasuhiro Kuroda  1
Affiliations
Review

Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Adult Patients

Akihiko Inoue et al. J Am Heart Assoc. .

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out-of-hospital cardiac arrest (OHCA) in adult patients. Although recent narrative and systematic reviews on extracorporeal life support in the emergency department are available in the literature, they are focused on the efficacy of ECPR, and no comprehensively summarized review on ECPR for OHCA in adult patients is available. In this review, we aimed to clarify the prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, with the aim of facilitating understanding among acute care physicians. The leading countries in the field of ECPR are those in East Asia followed by those in Europe and the United States. ECPR may reduce the risks of reperfusion injury and deterioration to secondary brain injury. Unlike conventional cardiopulmonary resuscitation, however, no clear prognostic markers have been identified for ECPR for OHCA. Bleeding was identified as the most common complication of ECPR in patients with OHCA. Future studies should combine ECPR with intra-aortic balloon pump, extracorporeal membrane oxygenation flow, target blood pressure, and seizure management in ECPR.

Keywords: complications; extracorporeal cardiopulmonary resuscitation; management; out‐of‐hospital cardiac arrest; pathophysiology; predictors; prevalence.

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Figures

Figure 1
Figure 1
Prevalence of extracorporeal cardiopulmonary resuscitation based on the published literature.
Figure 2
Figure 2
Pathophysiology of brain injury and effects of extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest. IL‐1 indicates interleukin 1; NMDA, N‐methyl‐D‐aspartate; NO, nitric oxide; NOS, nitric oxide synthase; RBC, red blood cell; ROS, reactive oxygen species; TNF‐α, tumor necrosis factor‐α; and WBC, white blood cell.
Figure 3
Figure 3
Complications related to extracorporeal cardiopulmonary resuscitation for patients with out‐of‐hospital cardiac arrest.
See this image and copyright information in PMC

References

    1. Maekawa K, Tanno K, Hase M, Mori K, Asai Y. Extracorporeal cardiopulmonary resuscitation for patients with out‐of‐hospital cardiac arrest of cardiac origin: a propensity‐matched study and predictor analysis. Crit Care Med. 2013;41:1186–1196. - PubMed
    1. Holmberg MJ, Geri G, Wiberg S, Guerguerian AM, Donnino MW, Nolan JP, Deakin CD, Andersen LW. International Liaison Committee on Resuscitation's Advanced Life S and Pediatric Task F . Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review. Resuscitation. 2018;131:91–100. - PMC - PubMed
    1. Ortega‐Deballon I, Hornby L, Shemie SD, Bhanji F, Guadagno E. Extracorporeal resuscitation for refractory out‐of‐hospital cardiac arrest in adults: a systematic review of international practices and outcomes. Resuscitation. 2016;101:12–20. - PubMed
    1. Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, Hase M, Tahara Y, Atsumi T; Group S‐JS . Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out‐of‐hospital cardiac arrest: a prospective observational study. Resuscitation. 2014;85:762–768. - PubMed
    1. Siao FY, Chiu CC, Chiu CW, Chen YC, Chen YL, Hsieh YK, Lee CH, Wu CT, Chou CC, Yen HH. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation. Resuscitation. 2015;92:70–76. - PubMed

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