A systematic review of current ECPR protocols. A step towards standardisation.

Area of Science:

• Cardiology
• Critical Care Medicine
• Emergency Medicine

Background:

• Conventional therapies for cardiac arrest are often insufficient.
• Extracorporeal cardiopulmonary resuscitation (ECPR) presents a potential advanced treatment option.
• Optimizing ECPR protocols is crucial for improving patient outcomes.

Purpose of the Study:

• To identify optimal ECPR protocols for survival with good neurological outcome.
• To evaluate current inclusion/exclusion criteria, cannulation strategies, and therapeutic measures.
• To determine factors influencing neurological survival in ECPR patients.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane).
• Eligible publications from June 2009 to June 2019 were included.
• Data from 1723 patients across 24 studies were analyzed.

Main Results:

• Good neurological outcome at discharge was observed in 21.3% of patients.
• Refractory cardiac arrest (RCA) was the most common inclusion criterion (84%).
• Percutaneous Seldinger technique was the preferred cannulation method (44%).

Conclusions:

• ECPR is a feasible intervention for cardiac arrest, even in early stages.
• Shorter time-to-ECPR, particularly with RCA defined within 10 minutes, is linked to better neurological survival.
• Percutaneous Seldinger technique with imaging guidance reduces cannulation time and complications.