Extracorporeal CPR

Conventional cardiopulmonary resuscitation (CPR) involves chest compressions and respiratory support with either mouth to mouth respiration or bag and mask ventilation. Extracorporeal CPR (ECPR) means supporting the heart and lung function using extracorporeal method of venoarterial perfusion during cardiac arrest [1]. Extracorporeal membrane oxygenator (ECMO) circuits are used in extracorporeal CPR.  The recently published 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [2] discusses the use of ECPR for cardiac arrest and also the potential ethical issues. Ethical issues arise as the decision to discontinue CPR in this situation becomes more complicated. ECPR may be considered in cases of refractory cardiac arrest when the cause of the cardiac arrest is likely to be reversible. No randomized controlled trials on ECPR have been published so far, though observational studies are available [3]. ECPR is implemented when there is no prompt return of spontaneous circulation (ROSC) with conventional CPR. In venoarterial ECMO, the venous blood is removed from a catheter placed in the right atrium through the femoral vein. The blood oxygenated by the ECMO device is returned through a catheter introduced via the femoral artery to the distal aorta. ECMO device differs from the conventional heart lung machine setup in that it is portable to be applied at the bedside and the catheters are introduced percutaneously o...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology CPR ECPR ROSC Source Type: blogs