Organisational approaches to the use of extracorporeal cardiopulmonary resuscitation for refractory out of hospital cardiac arrest: a narrative review

Abstract

Background: The objective of this narrative review was to provide an overview of how programmes around the world are organised regarding the use of extracorporeal cardiopulmonary resuscitation for refractory out of hospital cardiac arrest. Methods: A systematic literature search was performed in PubMed, EMBASE, ClinicalTrials.gov, the EU Clinical Trials Register, and Cochrane Library. The main parameters assessed were article type, region- population-size, cost–benefit analyses, inclusion and exclusion criteria, procedure location, team composition and outcome parameters reported. Results: Sixty-three articles were eligible for inclusion. One randomised trial had been published and 4 were ongoing. Among the 58 articles that reported data on organisational topics, 47 transported the patient to the hospital for cannulation, 10 initiated extracorporeal cardiopulmonary resuscitation on-scene and one did both. The organisations cover different populations sizes that ranged between 30,788–19,303,000 inhabitants. The most common inclusion criterion was a lower age limit of 18 years (in 86% articles), followed by an upper age limit (in 83% articles), but this varied (50 and 80 years). Other criteria were witnessed collapse (67%) and initial shockable rhythm (43%), asystole (3%), pulseless electrical activity (5%), pulmonary embolism (2%), and signs of life during cardio- pulmonary resuscitation (5%). The most common exclusion criterion was a Do-Not-Resuscitate order (38%) followed by existence of major comorbidities (36%). The extracorporeal cardiopulmonary resuscitation teams varied between 2–8 members and had various professions involved. Of the 44 studies reporting outcomes, 77% reported survival to hospital discharge. Outcome as one- (in 14%), 3- (in 5%) and 6-month survival (in 7%), Cerebral-Performance-Category-score of 1–2 was reported by 50% of the studies. Conclusion: There is variation in regional size, team composition, inclusion and exclusion criteria and reported outcomes. These discrepancies make it difficult to determine how to use extracorporeal cardiopulmonary resuscitation in the most effective manner from the current publications. Despite an increasing amount of research published in the last few years, there remains a need for better coherence to inclusion/exclusion criteria and outcome reporting, the optimal team composition and location for the procedure.