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Review
. 2025 Jul 28;14(15):5330.
doi: 10.3390/jcm14155330.

Extracorporeal CPR Performance Metrics in Adult In-Hospital Cardiac Arrest: A Stepwise and Evidence-Based Appraisal of the VA-ECMO Implementation Process

Timothy Ford  1 , Brent Russell  1 , Pritee Tarwade  1
Affiliations
Review

Extracorporeal CPR Performance Metrics in Adult In-Hospital Cardiac Arrest: A Stepwise and Evidence-Based Appraisal of the VA-ECMO Implementation Process

Timothy Ford et al. J Clin Med. .

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is an established intervention for select patients experiencing refractory cardiac arrest. Among modifiable predictors of survival and neurologic recovery during ECPR implementation, timely restoration of circulation remains critical in the setting of refractory cardiac arrest (CA). The in-hospital cardiac arrest (IHCA) setting is particularly amenable to reducing the low-flow interval through structured system-based design and implementation. Despite increasing utilization of ECPR, the literature remains limited regarding operational standards, quality improvement metrics, and performance evaluation. Establishing operational standards and performance metrics is a critical first step toward systematically reducing low-flow interval duration. In support of this aim, we conducted a comprehensive literature review structured around the Extracorporeal Life Support Organization (ELSO) framework for ECPR implementation. At each step, we synthesized evidence-based best practices and identified operational factors that directly influence time-to-circulation. Our goal is to provide a stepwise evaluation of ECPR initiation to consolidate existing best practices and highlight process components with potential for further study and standardization. We further evaluated the literature surrounding key technical components of ECPR, including cannula selection, placement technique, and positioning. Ongoing research is needed to refine and standardize each stage of the ECPR workflow. Developing optimized, protocol-driven approaches to ensure rapid, high-quality deployment will be essential for improving outcomes with this lifesaving but resource-intensive therapy.

Keywords: VA ECMO; adult; cardiac arrest; cardiopulmonary resuscitation; extracorporeal cardiopulmonary resuscitation; extracorporeal membrane oxygenation; in-hospital cardiac arrest.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish these results.

Figures

Figure 1
Figure 1
Visual Summary of Stepwise ECPR Implementation Process.
See this image and copyright information in PMC

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