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Review
. 2023 Oct 30;11(1):74.
doi: 10.1186/s40635-023-00558-8.

Extracorporeal cardiopulmonary resuscitation in 2023

Tobias Wengenmayer  1 , Eike Tigges  2 , Dawid L Staudacher  3
Affiliations
Review

Extracorporeal cardiopulmonary resuscitation in 2023

Tobias Wengenmayer et al. Intensive Care Med Exp. .
No abstract available

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Low-flow in ECPR. Time under resuscitation (low-flow) observed in randomized controlled trials (RCTs) are given. Three RCTs examined the role of extracorporeal cardiopulmonary resuscitation (ECPR) in patients following out-of-hospital cardiac arrest (OHCA). Time plays a crucial role in ECPR, as prognosis strongly correlates negatively with low-flow duration. The three primary intervals in refractory OHCA—time spent on the scene, during transportation, and for cannulation for ECMO—are presented. Delays not attributed to one of these three main aspects of ECPR (time on scene, transportation, and cannulation) are not shown. It is worth noting that the 'Arrest' [30] and 'Prague OHCA' [29] trials both were single-center trials, while the 'Inception' [12] trial was multi-centered
Fig. 2
Fig. 2
ECPR scenarios and distance of OHCA to the ECPR center. Potential scenarios for implementation of extracorporeal resuscitation (ECPR) in relation to the proximity of the place of out-of hospital cardiac arrest (OHCA) the ECPR center. Main aim is to minimize low-flow time. In the 'load and go' scenario, OHCA occurs in close proximity to the ECPR center. The victim is rapidly transported as soon as ECPR is designated as the treatment goal while the ECPR team assembles. The ‘on-site cannulation’ may save time when there is a significant expected transportation time. The ECPR team is alerted when an OHCA patient who qualifies for ECPR is identified and the team is transported to the site as quickly as possible. Although there is no transportation time until cannulation, the cannulation process itself may be challenging due to the unusual conditions. In more remote areas, a ‘rendezvous at initiation hospitals’, following the 'Minnesota model [107]', may be the optimal choice. Patients and the ECPR team convene at these dedicated hospitals, staffed with trained personnel. In all scenarios, it is theoretically possible to achieve ECPR cannulation and extracorporeal membrane oxygenation (ECMO) flow within a low-flow time of less than 60 min. Times given in this figure are estimates and not derived from clinical trials
Fig. 3
Fig. 3
Challenges in ECPR, an excerpt. Extracorporeal resuscitation (ECPR) must seamlessly integrate into a highly complex scenario. Patient-related factors, various stakeholders, and institutional variables all influence the outcome. Numerous factors must be continually addressed and adapted to ensure a streamlined process. In addition to the aspects outlined here, many more may be significant, depending on local standards and patient pathways
See this image and copyright information in PMC

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