Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest

Abstract

When conventional cardiopulmonary resuscitation (CCPR) cannot restore spontaneous circulation, the initiation of venoarterial extracorporeal membrane oxygenation during refractory cardiac arrest-known as extracorporeal CPR (ECPR)-might restore circulation and adequate tissue oxygenation. ECPR could substantially improve survival with favourable functional recovery. However, the complexity and time-sensitive nature of the intervention, high costs, resource demands, considerable risks, and complications restrict the availability of ECPR. Patient age and comorbidities, timely and effective CCPR, and time-to-ECPR are major contributors to the outcome of patients. The primary goal of ECPR is full recovery of the patient, but in some cases, transition to a long-term ventricular assist device or heart transplantation can be additional options for survival. In patients diagnosed with brain death or, according to local regulation, in those with irreversible post-anoxic brain damage, organ donation is possible after ECPR. Ongoing research aims to assess the efficacy of ECPR versus continued CCPR and uncover key prognostic indicators.