Acute Crit Care.  2020 Feb;35(1):1-9. 10.4266/acc.2020.00080.

Role of extracorporeal cardiopulmonary resuscitation in adults

Affiliations
  • 1Department of Thoracic and Cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) has been performed with increasing frequency worldwide to improve the low survival rate of conventional cardiopulmonary resuscitation (CCPR). Several studies have shown that among patients who experience in-hospital cardiac arrest, better survival outcomes and neurological outcomes can be expected after ECPR than after CCPR. However, studies have not clearly shown a short-term survival benefit of ECPR for patients who experience out-of-hospital cardiac arrest. Favorable outcomes are associated with a shorter low-flow time, an initial shockable rhythm, lower serum lactate levels, higher blood pH, and a lower Sequential Organ Failure Assessment score. Indications for ECPR include young age, witnessed arrest with bystander cardiopulmonary resuscitation, an initial shockable rhythm, correctable causes such as a cardiac etiology, and no return of spontaneous circulation within 10–20 minutes of CCPR. ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system, and it has the risk of several life-threatening complications. Therefore, physicians should carefully select patients for ECPR who can gain the most benefit, instead of applying ECPR indiscriminately.

Keyword

advanced cardiac life support; extracorporeal membrane oxygenation; cardiopulmonary resuscitation; out-of-hospital cardiac arrest

Figure

  • Figure 1. A typical example of in-hospital extracorporeal cardiopulmonary resuscitation (ECPR). There was two recovery of spontaneous circulation (ROSC) during whole CPR process. Extracorporeal circulation was successfully established after 35 minutes of resuscitation which includes 20 minutes of convectional resuscitation and 15 minutes of ROSC. ECPR is defined, despite pump-on during ROSC, if ROSC duration is less than 20 minutes. Because resuscitation is complex and various, like this example, there can be debates on this definition of ECPR. ECMO: extracorporeal membrane oxygenation.

  • Figure 2. Annual extracorporeal cardiopulmonary resuscitation (ECPR) episodes 2000-2016 [6]. According to Extracorporeal Life Support Organization registry, the number of ECPR has increased worldwide, and so has the survival rate. The recent reported survival to discharge was 23% to 31%.

  • Figure 3. Results reported by the meta-analysis by Kim et al. [11]. Risk ratios and 95% confidence intervals (CIs) were plotted in logarithmic scale. All outcomes, except for survival at discharge in out-of-hospital cardiac arrest (OHCA), favor extracorporeal cardiopulmonary resuscitation (ECPR), although there was a little in-study heterogeneity (red: IHCA, blue: OHCA). CCPR: conventional cardiopulmonary resuscitation; IHCA: in-hospital cardiac arrest; CPC: cerebral performance category; NA: not applicable.


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