Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-volume Extracorporeal Membrane Oxygenation...

Area of Science:

• Cardiology
• Critical Care Medicine
• Emergency Medicine

Background:

• Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an evolving treatment for cardiac arrest.
• High-volume extracorporeal membrane oxygenation (ECMO) centers can establish ECPR programs even without 24/7 availability.
• Effective patient selection is crucial for optimizing ECPR outcomes.

Purpose of the Study:

• To illustrate the process of establishing an ECPR program at a high-volume ECMO center.
• To highlight the importance of patient selection criteria in ECPR.
• To optimize outcomes for patients undergoing ECPR.

Main Methods:

• Presentation of two contrasting cases of cardiac arrest.
• Evaluation of ECPR candidacy based on service availability.
• ECMO cannulation during cardiopulmonary resuscitation for eligible patients.

Main Results:

• One patient with in-hospital cardiac arrest successfully underwent ECPR and survived with minimal complications.
• Another patient with out-of-hospital cardiac arrest and prolonged no-flow/low-flow time was deemed unsuitable for ECPR and did not survive.
• ECPR evaluation was feasible despite the absence of a dedicated 24/7 ECPR team.

Conclusions:

• ECPR program development requires robust protocols for patient selection and resource management.
• Case studies demonstrate the critical role of timely decision-making in ECPR.
• High-volume ECMO centers can implement ECPR protocols proactively, optimizing patient care.