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Can J Cardiol. 2018 Feb;34(2):146-155. doi: 10.1016/j.cjca.2017.08.015. Epub 2017 Sep 9.

Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application.

Author information

1
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; St Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: Brian.Grunau2@vch.ca.
2
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
3
Section of Cardiovascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada.
4
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; St Paul's Hospital, Vancouver, British Columbia, Canada.
5
Faculty of Medicine and Health Sciences, Universidad de Alcalá, Madrid, Spain; Helicopter Emergency Medical Service, Servicio de Urgencias Medicas de Madrid, Madrid, Spain.
6
Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada.
7
St Paul's Hospital, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
8
Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
9
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
10
McConnell Resource Centre, McGill University Health Centre, Montreal, Quebec, Canada.
11
Divisions of Cardiac Surgery and Critical Care Medicine, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.

Abstract

Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization.

PMID:
29249614
DOI:
10.1016/j.cjca.2017.08.015

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