A Systematic Review of Current ECPR Protocols. A Step Towards Standardisation

Overview

Journal Resusc Plus

Date 2021 Jul 5

PMID 34223301

Citations 21

Authors

t Joncke Koen

Thelinge Nathanael

Dewolf Philippe

Affiliations

Soon will be listed here.

Abstract

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Our goal was to identify the best protocol for survival with good neurological outcome through the evaluation of current inclusion criteria, exclusion criteria, cannulation strategies and additional therapeutic measures.

Methods: A systematic literature search was used to identify eligible publications from PubMed, Embase, Web of Science and Cochrane for articles published from 29 June 2009 until 29 June 2019.

Results: The selection process led to a total of 24 eligible articles, considering 1723 patients in total. A good neurological outcome at hospital discharge was found in 21.3% of all patients. The most consistent criterion for inclusion was refractory cardiac arrest (RCA), used in 21/25 (84%) of the protocols. The preferred cannulation method was the percutaneous Seldinger technique (44%).

Conclusion: ECPR is a feasible option for cardiac arrest and should already be considered in an early stage of CPR. One of the key findings is that time-to-ECPR seems to be correlated with good neurological survival. An important contributing factor is the definition of RCA. Protocols defining RCA as >10 min had a mean good neurological survival of 26.7%. Protocols with a higher cut-off, between 15 and 30 min, had a mean good neurological survival of 14.5%. Another factor contributing to the time-to-ECPR is the preferred access technique. A percutaneous Seldinger technique combined with ultrasonography and fluoroscopic guidance leads to a reduced cannulation time and complication rate. Conclusive research around prehospital cannulation still needs to be conducted.

Citing Articles

Database and geospatial mapping study of those eligible for extracorporeal cardiopulmonary resuscitation in the Thames Valley Region, England.

Millerchip O, Eddison J, Rosenberg A, Bailey J, Raitt J Resusc Plus. 2025; 22:100879.

PMID: 39996137 PMC: 11848498. DOI: 10.1016/j.resplu.2025.100879.

Comparing clinical only and combined clinical laboratory models for ECPR outcomes in refractory cardiac arrest.

Chiu C, Chang Y, Chiu C, Chen Y, Hsieh Y, Hsiao S Sci Rep. 2025; 15(1):2915.

PMID: 39849010 PMC: 11757996. DOI: 10.1038/s41598-025-87200-7.

Long-term outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest: Analysis of EXCEL registry data.

Pound G, Jones D, Eastwood G, Paul E, Neto A, Hodgson C Crit Care Resusc. 2025; 26(4):279-285.

PMID: 39816674 PMC: 11734221. DOI: 10.1016/j.ccrj.2024.08.008.

Enhancing survival in cardiac arrest: the urgent need for optimized extracorporeal cardiopulmonary resuscitation implementation and protocols - editorial.

Waheed A, Gul M, Naeem R, Raja H, Wardak A, Khan U Ann Med Surg (Lond). 2024; 86(12):6926-6929.

PMID: 39649917 PMC: 11623826. DOI: 10.1097/MS9.0000000000002740.

Clinicians' experience of barriers and facilitators to care delivery of an extracorporeal cardiopulmonary resuscitation service for out-of-hospital cardiac arrest: a qualitative survey.

Eddison J, Millerchip O, Rosenberg A, Lewinsohn A, Raitt J Scand J Trauma Resusc Emerg Med. 2024; 32(1):86.

PMID: 39272171 PMC: 11401370. DOI: 10.1186/s13049-024-01261-7.

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