Are You Ready For Extracorporeal Cardiopulmonary Resuscitation?
Su Jin Kim1
1Emergency Medicine, College of Medicine, Korea University, Republic of Korea
Global incidence of ‘Extracorporeal membrane oxygenation (ECMO) support’ including extracorporeal cardiopulmonary resuscitation (ECPR) in the patients with out-of-hospital cardiac arrest (OHCA) is increasing. There is still controversy about the superiority of ECPR compared with conventional cardiopulmonary resuscitation and adequate indications in OHCA patients. The outcomes and indications of ECPR may vary depending on patient characteristics, Emergency Medical Service system & emergency department (ED) protocol, hospital factors (ex: volume, facilities and patient selection protocol), education/quality improvement and Culture and so on. In Korea, emergency physician-initiated, emergency department-based ECPR in the patients with OHCA has been applied since 2006. Considering the variations of country, culture, and hospital settings is important to developing and implementing the adequate ED-based ECPR program for expecting better outcome despite costly and resource-intensive needs. Based on our experiences of emergency physician-initiated ECPR in OHCA patients in the ED and review of other studies about ED-ECMO program, we discuss about ED-ECPR program, focused on pre-hospital phase, in-hospital phase, ECPR protocol, multidisciplinary approach for post-cardiac arrest care and ECMO care, 24 hour-available facilities and equipment for ECPR, regional quality improvement. Understanding these points with the regional variations, is necessary to implement the best ED-ECMO program including patient selection, from the community to the hospital.
1) Grunau B, Hornby L, Singal RK, et al. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application. The Canadian journal of cardiology. 2018;34(2):146-55.
2) Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367(20):1912-20.
3) Lee SW, Hong YS. Extracorporeal life-support in patients requiring CPR. Lancet. 2008;372(9638):512-4.
4) Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: A propensity-matched study. Critical Care. 2014;18(5):1-15.
5) Kim SJ, Kim HJ, Lee HY, Ahn HS, Lee SW. Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis. Resuscitation. 2016.
6) Han KS, Kim SJ, Lee EJ, Jung JS, Park JH, Lee SW. Experience of extracorporeal cardiopulmonary resuscitation in a refractory cardiac arrest patient at the emergency department. Clinical cardiology. 2019;42(4):459-66.
7) Tonna JE, Selzman CH, Mallin MP, Smith BR, Youngquist ST, Koliopoulou A, et al. Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program. Annals of emergency medicine. 2017;70(1):32-40.
8) Brooks SC, Shemie SD, Torrance S, Hornby L, Gillrie C, Grunau B, et al. Barriers and opportunities related to extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Canada: A report from the first meeting of the Canadian ECPR Research Working Group. Cjem. 2018;20(4):507-17.
9) Lamhaut L, Hutin A, Puymirat E, Jouan J, Raphalen JH, Jouffroy R, et al. A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis. Resuscitation. 2017;117:109-17.