Extracorporeal life support in the emergency department: A narrative review for the emergency physician

Swol, Justyna; Bělohlávek, Jan; Brodie, Daniel; Bellezzo, Joseph; Weingart, Scott D.; Shinar, Zachary; Schober, Andreas; Bachetta, Matthew; Haft, Jonathan W.; Ichiba, Shingo; Sakamoto, Tetsuya; Peek, Giles J.; Lorusso, Roberto; Conrad, Steven A.

doi:10.1016/j.resuscitation.2018.10.014

Cited by 50 publications

(48 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Considering that emergency physicians provide the first medical contact in all critical patients, including those with cardiac arrest, prompt patient selection and ECMO initiation by emergency physicians might improve survival rates. This suggestion aligns with a recently published review [17], where the authors stated that ECMO may be a useful tool in the hands of emergency physicians when a life-threatening situation is present. Furthermore, well-established ED ECMO programs for OHCA patients exist in the literature [18].…”

Section: Discussionsupporting

confidence: 83%

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Özlüer¹,

Avcil²,

Ege³

et al. 2021

Turk J Med Sci

View full text Add to dashboard Cite

Background/aim: The primary purpose of this study is to report the experience on the extracorporeal membrane oxygenation (ECMO) process for patients in the critical care unit (CCU) of an Emergency Department of a tertiary hospital in Turkey, from cannulation to decannulation, including follow-up procedures. Materials and Methods: This retrospective, observational study included eight patients who received Extracorporeal Membrane Oxygenation from Jan 2018-Jan 2020. We evaluated the demographics, indications for ECMO, laboratory values, Respiratory ECMO Survival Prediction, Survival After Veno-Arterial ECMO and ECMOnet scores, the management process, and patient outcomes. Blood gas analyses from after the first hour of ECMO initiation and the re-evaluation of the patients' Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at the 24 th hour of ECMO were recorded. Results: The mean age was 52.7 ± 14.2 years. The median duration of the ECMO run was 81 (min-max: 4-267) hours, and the mean length of CCU stay was 10.2 ± 6.7 days. Of the 8 patients studied, 5 (62.5%) had veno-arterial and 3 (37.5%) had veno-venous ECMO. Three patients were successfully weaned (37.5%). The overall survival-to-discharge rate was 25%. Carbon dioxide levels were significantly decreased 1 hour after ECMO initiation (p=0.038) as well as the need for vasopressors. Lactate levels were lower in decannulated patients. Changes in the 2 APACHE II score were more consistent with the clinical deterioration in patients than were SOFA score changes. Conclusions: In the early phase of ECMO, vital signs improve, and the need for vasopressors and carbon dioxide levels decreases. Thus, CCUs in Emergency Departments with ECMO capabilities could potentially be designed, and emergency department ECMO algorithms could be tailored for critically ill in addition to outof-hospital cardiac arrest (OHCA) patients.

show abstract

Section: Discussionsupporting

confidence: 83%

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Özlüer¹,

Avcil²,

Ege³

et al. 2021

Turk J Med Sci

View full text Add to dashboard Cite

show abstract

“…17,18 The fact that CA is unwitnessed is considered as a contraindication to ECPR. 19,20 Unwitnessed cardiac arrest patients are, therefore, often deemed ineligible for ECPR clinical protocols when the no-flow duration is unknown. [19][20][21] The duration of CPR corresponding to a low-flow prolonged to the extent that brain recovery is doubtful (about 60-80 min), is also considered as a contraindication to ECPR.…”

Section: Overall Survival Ratementioning

confidence: 99%

“…[19][20][21] The duration of CPR corresponding to a low-flow prolonged to the extent that brain recovery is doubtful (about 60-80 min), is also considered as a contraindication to ECPR. [19][20][21][22] The median low-flow duration of 105 minutes for neurologically intact survivors in our study is much longer than median CPR durations of normothermic CA patients undergoing ECPR. 23 These figures suggest that the criteria to qualify normothermic CA patients for ECPR do not apply in the same way for hypothermic CA.…”

Section: Overall Survival Ratementioning

confidence: 99%

Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review

et al. 2020

View full text Add to dashboard Cite

Prolonged cardiac arrest (CA) may lead to neurologic deficit in survivors. Good outcome is especially rare when CA was unwitnessed. However, accidental hypothermia is a very specific cause of CA. Our goal was to describe the outcomes of patients who suffered from unwitnessed hypothermic cardiac arrest (UHCA) supported with Extracorporeal Life Support (ECLS). We included consecutive patients’ cohorts identified by systematic literature review concerning patients suffering from UHCA and rewarmed with ECLS. Patients were divided into four subgroups regarding the mechanism of cooling, namely: air exposure; immersion; submersion; and avalanche. A statistical analysis was performed in order to identify the clinical parameters associated with good outcome (survival and absence of neurologic impairment). A total of 221 patients were included into the study. The overall survival rate was 27%. Most of the survivors (83%), had no neurologic deficit. Asystole was the presenting CA rhythm in 48% survivors, of which 79% survived with good neurologic outcome. Variables associated with survival included the following: female gender (P < .001); low core temperature (P = .005); non‐asphyxia‐related mechanism of cooling (P < .001); pulseless electrical activity as an initial rhythm (P < .001); high blood pH (P < .001); low lactate levels (P = .003); low serum potassium concentration (P < .001); and short resuscitation duration (P = .004). Severely hypothermic patients with unwitnessed CA may survive with good neurologic outcome, including those presenting as asystole. The initial blood pH, potassium, and lactate concentration may help predict outcome in hypothermic CA.

show abstract

“…One of the most important factors that influences outcomes in ECPR cases is the time from arrest to initiation of ECMO flow . POCUS with RESCUE‐TEE has been shown to improve resuscitation quality and efficiency of initiating ECPR (early flow time) which is associated with improved ECPR survival rates …”

Section: Discussionmentioning

confidence: 99%

RESCUE transesophageal echocardiography for monitoring of mechanical chest compressions and guidance for extracorporeal cardiopulmonary resuscitation cannulation in refractory cardiac arrest

Giorgetti

Chiricolo

Melniker

et al. 2019

J of Clinical Ultrasound

View full text Add to dashboard Cite

There is a growing interest in using point‐of‐care transesophageal echocardiography (TEE) during cardiac arrest. TEE is effective at identifying the etiology of sudden cardiovascular collapse and guiding management during the resuscitation. In selected patients with refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) can be considered. ECPR requires percutaneous vascular access for the implantation of veno‐arterial extracorporeal membrane oxygenation circuit. We present a case of prolonged cardiac arrest in which rescue TEE was pivotal in narrowing the differential diagnosis, monitoring of mechanical chest compression performance, and guiding cannulation for ECPR.

show abstract

Extracorporeal life support in the emergency department: A narrative review for the emergency physician

Cited by 50 publications

References 84 publications

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review

RESCUE transesophageal echocardiography for monitoring of mechanical chest compressions and guidance for extracorporeal cardiopulmonary resuscitation cannulation in refractory cardiac arrest

Contact Info

Product

Resources

About