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Review
. 2022 Dec 9;58(12):1815.
doi: 10.3390/medicina58121815.

Extracorporeal Cardiopulmonary Resuscitation: A Narrative Review and Establishment of a Sustainable Program

Chris M Cassara  1 , Micah T Long  1 , John T Dollerschell  1 , Floria Chae  2 , David J Hall  3 , Gozde Demiralp  1 , Matthew J Stampfl  4 , Brittney Bernardoni  4 , Daniel P McCarthy  3 , Joshua M Glazer  4
Affiliations
Review

Extracorporeal Cardiopulmonary Resuscitation: A Narrative Review and Establishment of a Sustainable Program

Chris M Cassara et al. Medicina (Kaunas). .

Abstract

The rates of survival with functional recovery for out of hospital cardiac arrest remain unacceptably low. Extracorporeal cardiopulmonary resuscitation (ECPR) quickly resolves the low-flow state of conventional cardiopulmonary resuscitation (CCPR) providing valuable perfusion to end organs. Observational studies have shown an association with the use of ECPR and improved survivability. Two recent randomized controlled studies have demonstrated improved survival with functional neurologic recovery when compared to CCPR. Substantial resources and coordination amongst different specialties and departments are crucial for the successful implementation of ECPR. Standardized protocols, simulation based training, and constant communication are invaluable to the sustainability of a program. Currently there is no standardized protocol for the post-cannulation management of these ECPR patients and, ideally, upcoming studies should aim to evaluate these protocols.

Keywords: ECPR vs. CCPR; cardiopulmonary resuscitation; extracorporeal; post-cannulation management; program development.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An example of a post-ECPR-cannulation checklist. ECMO MD = cannulating physician; ED MD = emergency medicine physician; perfusion/ES = perfusionist or ECMO specialist; ICU MD/Fellow = critical care physician. CI = cardiac index. MAP = mean arterial pressure. STEMI = ST segment elevation myocardial infarction. Access Center = centralized paging and operator resource for the hospital system. POCUS = point-of-care ultrasound. FdO2 = fraction of delivered oxygen. LV = left ventricular. B4/5 = institutional cardiothoracic ICU (or wherever adult VA ECMO patients are managed). PICU = pediatric intensive care unit.
Figure 2
Figure 2
Projected time from witnessed arrest to ECMO cannulation. This map describes time-to-ROEC for patients, assuming a 2-min delay in calling 911. It integrates historic scene–response time based on geographic location (typically <5 min county-wide), a 16-min on-scene resuscitation by paramedics, rapid transport back to the Emergency Department (drive-times are based on Wednesday at 0830, the 75th percentile for this metric), and a 15 min door-to-cannulation time. The latter is ambitious, but in line with our simulated and historic times. Color-coded boxes reflect the minimum projected time-to-ROEC. Accordingly, the outer “60 min” area is considered feasible only under ideal circumstances and for excellent ECPR candidates.
See this image and copyright information in PMC

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