Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO)

Abstract

Purpose To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. Methods We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. Results Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤ 3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow®. Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists. Conclusions Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable.

Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest—An ELSO registry study

“…While similar descriptive analyses of ECPR process variables and complication rates exist for cardiac arrests of all locations (being comprised of mostly IHCA patients) [16], this is the first ELSO registry-based descriptive analysis of ECPR for strictly OHCA. The vessels cannulated and cannula diameter used from this large international registry-based study are similar to prior reports of such process variables from smaller case series or single regions [8–15,21]. The observed overall median duration of ECPR of 47 h, with a significantly longer duration in survivors than non-survivors (78 vs 37 h, p < 0.05), is within range of prior widely varying reports of ECPR duration following OHCA (10–156 h [2,3,8,9,12,14,15,19]).…”

Extracorporeal cardiopulmonary resuscitation

“…Intensive care specialists experienced with ECLS cannulation perform percutaneous ECPR cannulation in some centres. A recent survey of US centers that perform emergency room ECLS suggested that 15% of emergency department-based ECLS programs do not utilize cardiothoracic surgeons (51).…”

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

“…Brought to you by | MIT Libraries Authenticated Download Date | 5/13/18 9:44 AM clusion criteria when selecting a patient for ECPR [16]. Generally, it is recommended that the interdisciplinary team should be activated in order to decide whether or not to initiate ECPR in patients who do not present with any sign of a return of spontaneous circulation (ROSC) after ten minutes of advanced cardiac life support [17].…”