Extracorporeal life support in adult patients with out-of-hospital cardiac arrest

Abstract

The use of extracorporeal life support in cardiopulmonary resuscitation (CPR) of adult patients experiencing out-of-hospital cardiac arrest by the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest has been increasing over the past decade. This can be attributed to the encouraging results of extracorporeal CPR (ECPR) in multiple observational studies. To date, only one randomised controlled trial has compared ECPR to conventional advanced life support measures. Patient selection is crucial for the success of ECPR programmes. A rapid and organised approach is required for resuscitation, i.e. cannula insertion with ECMO pump initiation in combination with other aspects of post-cardiac arrest care such as targeted temperature management and early coronary reperfusion. The provision of an ECPR service can be costly, resource intensive and technically challenging, as limited studies have reported on its cost-effectiveness.

SRFAC: resuscitation and saving lives in the COVID-19 era and beyond

“…ECMO remains a costly intervention with significant complications; hence, care must be taken in case selection while balancing the risks versus benefits and cost-effectiveness when designing an ECPR response system. (12) Paediatrics A framework using the 'paediatric chain of neurologically intact survival' is used to provide guidance in paediatric life support. The use of adult recommendations for paediatrics has been changed from above eight years of age to above 12 years of age.…”