Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxyg...

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Veröffentlicht in:Intensive care medicine Jg. 48; H. 1; S. 1 - 15
Hauptverfasser: Abrams, Darryl, MacLaren, Graeme, Lorusso, Roberto, Price, Susanna, Yannopoulos, Demetris, Vercaemst, Leen, Bělohlávek, Jan, Taccone, Fabio S., Aissaoui, Nadia, Shekar, Kiran, Garan, A. Reshad, Uriel, Nir, Tonna, Joseph E., Jung, Jae Seung, Takeda, Koji, Chen, Yih-Sharng, Slutsky, Arthur S., Combes, Alain, Brodie, Daniel
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2022
Springer
Springer Nature B.V
Springer Verlag
Schlagworte:
Adult
Adults
Anesthesiology
Cardiac arrest
Cardiopulmonary resuscitation
Cardiopulmonary Resuscitation - methods
Clinical trials
Cost-Benefit Analysis
CPR
CPR (First aid)
Critical Care Medicine
Economic impact
Emergency Medicine
Extracorporeal membrane oxygenation
Extracorporeal Membrane Oxygenation - methods
Health care
Heart
Heart attacks
Humans
Impact analysis
Intensive
Intensive care
Life Sciences
Medical care, Cost of
Medical equipment
Medical prognosis
Medicine
Medicine & Public Health
Narrative Review
Organs
Out-of-Hospital Cardiac Arrest - therapy
Oxygenation
Pain Medicine
Patients
Pediatrics
Perfusion
Physiological apparatus
Pneumology/Respiratory System
Recovery of function
Resuscitation
Survival
Therapy
New York
United States
Washington, D.C
Extracorporeal membrane oxygenation
OHCA
Cardiac arrest
Extracorporeal cardiopulmonary resuscitation
IHCA
ISSN:0342-4642, 1432-1238, 1432-1238
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Zusammenfassung:Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.
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ObjectType-Feature-2
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PMCID: PMC8429884
ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-021-06514-y