Benefits, Key Protocol Components, and Considerations for Successful Implementation of Extracorporeal Cardiopulmonary Resuscitation: a Review of the Recent Literature

Overview

Journal Clin Exp Emerg Med

Specialty Emergency Medicine

Date 2023 Jul 13

PMID 37439142

Authors

Kyung Woon Jeung

Yong Hun Jung

Jorge Antonio Gumucio

David D Salcido

James J Menegazzi

Affiliations

Soon will be listed here.

Abstract

The application of venoarterial extracorporeal membrane oxygenation (ECMO) in patients unresponsive to conventional cardiopulmonary resuscitation (CPR) has significantly increased in recent years. To date, three published randomized trials have investigated the use of extracorporeal CPR (ECPR) in adults with refractory out-of-hospital cardiac arrest. Although these trials reported inconsistent results, they suggest that ECPR may have a significant survival benefit over conventional CPR in selected patients only when performed with strict protocol adherence in experienced emergency medical services-hospital systems. Several studies suggest that identifying suitable ECPR candidates and reducing the time from cardiac arrest to ECMO initiation are key to successful outcomes. Prehospital ECPR or the rendezvous approach may allow more patients to receive ECPR within acceptable timeframes than ECPR initiation on arrival at a capable hospital. ECPR is only one part of the system of care for resuscitation of cardiac arrest victims. Optimizing the chain of survival is critical to improving outcomes of patients receiving ECPR. Further studies are needed to find the optimal strategy for the use of ECPR.

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