Role of extracorporeal cardiopulmonary resuscitation in adults

• Published in: Acute and critical care Vol. 35; no. 1; pp. 1 - 9
• Main Authors: Kim, Hongsun, Cho, Yang Hyun
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Critical Care Medicine 01.02.2020; 대한중환자의학회
• Subjects: advanced cardiac life support; cardiopulmonary resuscitation; extracorporeal membrane oxygenation; out-of-hospital cardiac arrest; Review; 마취과학; cardiopulmonary resuscitation; extracorporeal membrane oxygenation; advanced cardiac life support; out-of-hospital cardiac arrest
• ISSN: 2586-6052; 2586-6060; 2586-6060
• DOI: 10.4266/acc.2020.00080

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.