Extracorporeal Pulmonary Resuscitation (ECPR) of Out-of-Hospital Cardiac Arrest

For decades, extracorporeal life support (commonly referred to as extracorporeal membrane oxygenation, or ECMO) was used in the operating room (OR) and ICU to treat refractory shock, typically after surgery. More recently, ECMO has been used to treat refractory cardiac arrest; in this indication, it takes the name “ECPR.” Today, ECPR is used in many places.
Although there are published case reports, series and after/before studies, there have been no randomized controlled trials to illustrate its effectiveness in the resuscitation of out-of-hospital cardiac arrest (OHCA) patients.
However, ECPR is now recommended by international guidelines in the management of refractory OHCA of suspected reversible cause, such as acute myocardial infarction, refractory cardiac arrest of suspected reversible cause, pulmonary embolism and intoxication.1 The 2015 American Heart Association Guidelines recommend ECPR could be considered in refractory cardiac arrest of suspected reversible cause.2
ECPR is the second line of treatment for OHCA not responding to usual BLS and ALS treatments (e.g., cardiac compressions/ massage, ventilation, defibrillation, drug administration, etc.). ECPR brings respiratory and circulatory support, ensuring sufficient blood and oxygen supply to the whole body, especially the brain.
The ECPR response team in Paris implements ECMO on scene to restore blood flow to the body and limit ischemic consequences to the brain and coronary arteries. The hybrid implementati...

Source: JEMS Patient Care - February 27, 2019 Category: Emergency Medicine Authors: Lionel Lamhaut, MD, PhD Tags: Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Heart of America Source Type: news