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Review
. 2024 Mar 1;52(3):483-494.
doi: 10.1097/CCM.0000000000006102. Epub 2023 Nov 3.

Post-Cardiac Arrest Care in Adult Patients After Extracorporeal Cardiopulmonary Resuscitation

Jin Kook Kang  1 , Zachary Darby  1 , Thomas P Bleck  2 , Glenn J R Whitman  1 , Bo Soo Kim  1   3 , Sung-Min Cho  1   4
Affiliations
Review

Post-Cardiac Arrest Care in Adult Patients After Extracorporeal Cardiopulmonary Resuscitation

Jin Kook Kang et al. Crit Care Med. .

Abstract

Objectives: Extracorporeal cardiopulmonary resuscitation (ECPR) serves as a lifesaving intervention for patients experiencing refractory cardiac arrest. With its expanding usage, there is a burgeoning focus on improving patient outcomes through optimal management in the acute phase after cannulation. This review explores systematic post-cardiac arrest management strategies, associated complications, and prognostication in ECPR patients.

Data sources: A PubMed search from inception to 2023 using search terms such as post-cardiac arrest care, ICU management, prognostication, and outcomes in adult ECPR patients was conducted.

Study selection: Selection includes original research, review articles, and guidelines.

Data extraction: Information from relevant publications was reviewed, consolidated, and formulated into a narrative review.

Data synthesis: We found limited data and no established clinical guidelines for post-cardiac arrest care after ECPR. In contrast to non-ECPR patients where systematic post-cardiac arrest care is shown to improve the outcomes, there is no high-quality data on this topic after ECPR. This review outlines a systematic approach, albeit limited, for ECPR care, focusing on airway/breathing and circulation as well as critical aspects of ICU care, including analgesia/sedation, mechanical ventilation, early oxygen/C o2 , and temperature goals, nutrition, fluid, imaging, and neuromonitoring strategy. We summarize common on-extracorporeal membrane oxygenation complications and the complex nature of prognostication and withdrawal of life-sustaining therapy in ECPR. Given conflicting outcomes in ECPR randomized controlled trials focused on pre-cannulation care, a better understanding of hemodynamic, neurologic, and metabolic abnormalities and early management goals may be necessary to improve their outcomes.

Conclusions: Effective post-cardiac arrest care during the acute phase of ECPR is paramount in optimizing patient outcomes. However, a dearth of evidence to guide specific management strategies remains, indicating the necessity for future research in this field.

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Conflict of interest statement

Dr. Bleck received funding from Marinus Pharmaceuticals, SAGE Corporation, iECURE, and Ceribell Corporation. Dr. Whitman received funding from Avania. Dr. Cho is funded by National Heart, Lung, and Blood Institute (1K23HL157610). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Illustration of the steps taken immediately after cannulation.
Figure 2.
Figure 2.
A proposed protocol describing the recommended approach to analgosedation during ECMO support.
See this image and copyright information in PMC

References

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    1. Suverein MM, Delnoij TSR, Lorusso R, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. New England Journal of Medicine 2023; 388:299–309 - PubMed

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