ECMO CPR is peripheral V-A ECMO deployed in patients undergoing advanced life support (ALS) for cardiac arrest. The evidence for this procedure is limited but clinical trial are currently underway. Initial case series suggest greater than 30% survival to hospital discharge.
It is indicated in select patients with refractory cardiac arrest when conventional ALS is unable to achieve return of spontaneous circulation (ROSC).
Trial Inclusion Criteria
- Patient <70 years old
- Witnessed arrest
- Bystander CPR
- Initial rhythm NOT asystole
- Presumed reversible cause
- Less than 60 minutes since collapse
- No preexisting condition that would preclude return to independent living
Logistics
ECPR is a complex intervention requiring coordination of a large multidisciplinary team. It requires dedicated planning and systematic training to be deployed effectively. Key elements include
Activation
- Single call activates all team members
- Initiated by first responder to cardiac arrest based on the inclusion criteria
Pre-Cannulation Phase
- Ongoing high quality ALS
- Exclude reversible causes (echo, VBG)
- Institute mechanical compressions
- Monitor EtCO2
- Determine eligibility for ECPR
Cannulation Phase
- Cease defibrilation
- Ultrasound guided percutaneous femoral access
- Confirmation of wire placement of echo
- Commencement of VVA ECMO
Post Cannulation Phase
- Secure Lines
- Defibrilation if appropriate
- Inotropes to achieve ventricular ejection
- Transport to cath lab or definitive treatment
Evidence
The EDECMO reviews some of the early studies of ECMO CPR on their website & podcast
More recently the CHEER protocol has been shown to improve survival with favourable neurological outcome following cardiac arrest compared with historical data. It works and works very well in an experienced ECMO centre, with engagement of pre-hospital services and as part of a bundle. A multi-centre RCT is now required to determine if these impressive results can be replicated. Read an evidence based summary of the article via the Bottom Line.
