Implementing enhanced extracorporeal membrane oxygenation for CPR (ECPR) in the emergency department

Implementing enhanced extracorporeal membrane oxygenation for CPR (ECPR) in the emergency department

ECMO, ECPR, Cardiac, Arrest, Resuscitation

Abstract

Refractory out-of-hospital cardiac arrest (OHCA) has a very poor prognosis, with survival rates at around 10%. Extra-
corporeal membrane oxygenation (ECMO) for patients in refractory arrest, known as ECPR, aims to provide perfusion

to the patient whilst the underlying cause of arrest can be addressed. ECPR use has increased substantially, with vary-
ing survival rates to hospital discharge. The best outcomes for ECPR occur when the time from cardiac arrest to imple-
mentation of ECPR is minimised. To reduce this time, systems must be in place to identify the correct patient, expedite

transfer to hospital, facilitate rapid cannulation and ECMO circuit flows. We describe the process of activation of ECPR,
patient selection, and the steps that emergency department clinicians can utilise to facilitate timely cannulation

to ensure the best outcomes for patients in refractory cardiac arrest. With these processes in place our survival to hos-
pital discharge for OHCA patients is 35%, with most patients having a good neurological function.

Keywords ECMO, ECPR, Cardiac, Arrest, Resuscitation

Matthew Oliver1,2,3* , Andrew Coggins2,4, Natalie Kruit2,5,6,10, Brian Burns2,6, Brian Plunkett7

, Steve Morgan8
,

Tim J. Southwood9

, Richard Totaro9

, Paul Forrest10, Saartje Berendsen Russell1,3, Ruaidhri Carey9 and

Mark Dennis2,11

https://doi.org/10.1186/s12245-024-00652-y

2024

Peri Irawan

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