Candidacy Decision Making for Extracorporeal Cardiopulmonary Resuscitation (ECPR): Lessons from a Single-Center...

Area of Science:

• Cardiology
• Critical Care Medicine
• Medical Ethics

Background:

• Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly utilized for cardiac arrest patients.
• Lack of standardized criteria leads to inconsistent ECPR candidacy decisions across and within institutions.

Purpose of the Study:

• To analyze ECPR decision-making processes at a single center.
• To identify patterns of inconsistency in ECPR candidacy.
• To propose a model for consistent ECPR decision-making.

Main Methods:

• Retrospective cohort study of 73 patients considered for ECPR.
• Analysis of ECPR consultations, candidate selection, and invoked contraindications.
• Identification of patterns of inconsistency in decision-making.

Main Results:

• 14 patients underwent ECPR; 53 did not. Common contraindications included CPR duration, age, rhythm, comorbidities, and acidemia.
• Five patterns of inconsistency were identified in contraindication application, documentation, and terminology.
• A Domain-Based Decision-Making model was proposed.

Conclusions:

• An internal review process can effectively assess ECPR candidacy decision-making.
• The proposed Domain-Based Decision-Making model aims to mitigate inconsistencies.
• Lessons learned are applicable to other ECPR centers.