Immediate post-ECPR management strategies in the prehospital and critical care transport medicine environments

Ella Purington¹, Christopher R Shaw², Erica Berglund¹, Bronwyn Finney^{1

3}, Jeffrey Dellavolpe^{4

5}, Mark Dennis^{6

7}, Dinis Reis Miranda^{8

9}, Alice Hutin¹⁰, Andrea M Elliott^{11

12}, Jason A Bartos^{11

12}, Cindy H Hsu^{1

13}, Brittney Bernardoni^{14

15}, Michael J Lauria^{16

17}, Adam L Gottula^{18

19}

Affiliations

¹ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
² Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
³ Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
⁴ The Institute for Extracorporeal Life Support, San Antonio, TX, USA.
⁵ Texas IPS, San Antonio, TX, USA.
⁶ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁷ Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁸ Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, The Netherlands.
⁹ Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
¹⁰ SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹¹ Cardiovascular Division, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
¹² Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
¹³ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
¹⁴ Departments of Emergency Medicine and Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁵ Med Flight, UW Health, Madison, WI, USA.
¹⁶ Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
¹⁷ Airlift Northwest, Seattle, WA, USA.
¹⁸ Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA. gottulaa1@gmail.com.
¹⁹ Department of Anesthesiology, University of Minnesota School of Medicine, Mayo Memorial Building, B515, 420 Delaware St SE, Minneapolis, MN, 55455, USA. gottulaa1@gmail.com.

PMID: 40775792
PMCID: PMC12330060
DOI: 10.1186/s13049-025-01448-6

Review

Immediate post-ECPR management strategies in the prehospital and critical care transport medicine environments

Ella Purington et al. Scand J Trauma Resusc Emerg Med. 2025.

. 2025 Aug 7;33(1):135.

doi: 10.1186/s13049-025-01448-6.

Authors

Affiliations

¹ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
² Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
³ Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
⁴ The Institute for Extracorporeal Life Support, San Antonio, TX, USA.
⁵ Texas IPS, San Antonio, TX, USA.
⁶ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁷ Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁸ Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, The Netherlands.
⁹ Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
¹⁰ SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹¹ Cardiovascular Division, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
¹² Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
¹³ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
¹⁴ Departments of Emergency Medicine and Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁵ Med Flight, UW Health, Madison, WI, USA.
¹⁶ Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
¹⁷ Airlift Northwest, Seattle, WA, USA.
¹⁸ Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA. gottulaa1@gmail.com.
¹⁹ Department of Anesthesiology, University of Minnesota School of Medicine, Mayo Memorial Building, B515, 420 Delaware St SE, Minneapolis, MN, 55455, USA. gottulaa1@gmail.com.

PMID: 40775792
PMCID: PMC12330060
DOI: 10.1186/s13049-025-01448-6

Abstract

Despite advancements in care, out-of-hospital cardiac arrest has a low survival rate. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown improved outcomes in select cases, notably in the ARREST trial. However, ECPR is resource-intensive and limited to specialized centers, restricting access in many regions. Estimates suggest only 2-10% of out-of-hospital cardiac arrest patients are ECPR candidates. Advanced systems initiating ECPR in prehospital environments or non-ECMO-capable centers have shown promise. As ECPR utilization increases, so does the need for transport to ECMO-capable centers. Unlike conventional out-of-hospital cardiac arrest care, high-quality evidence for post-resuscitation management of ECPR patients is lacking. This review provides suggestions for the immediate post-resuscitation management (4-6 h) of ECPR patients in prehospital settings, the critical care transport medicine environment, and at non-ECMO-capable centers. Goals include treating the precipitating cause of cardiac arrest, maintaining end-organ perfusion, optimizing oxygen delivery, promoting myocardial recovery, and preventing complications associated with V-A ECMO. Continued research is needed to establish evidence-based protocols that ensure the safe and effective management of ECPR patients.

Keywords: Cardiogenic shock; Critical care transport medicine; Extracorporeal cardiopulmonary resuscitation; Prehospital medicine; Systems of care.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: This study was exempted for review by the University of Michigan Institutional Review Board. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
A timeline of prehospital ECPR, on-scene stabilization, and critical care transport to an ECPR center. ECPR: extracorporeal cardiopulmonary resuscitation; EMS: emergency medical services; CCTM: critical care transport medicine; OHCA: out of hospital cardiac arrest

**Fig. 2**
Demonstrates securement of femoral-femoral venoarterial ECMO cannulas. Each cannula is secured by a purse-string suture (A) at the insertion site and at a minimum of two additional sites distal to the cannula insertion site(B, C). Distal securement sites can be secured with either sutures or commercial securement devices based on local protocols (B, C). Zip ties are used to connect the cannulas to the ECMO circuit (D)

See this image and copyright information in PMC

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Immediate post-ECPR management strategies in the prehospital and critical care transport medicine environments

Affiliations

Immediate post-ECPR management strategies in the prehospital and critical care transport medicine environments

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials