Naslov
Extracorporeal Cardiopulmonary Resuscitation (eCPR) - is it ready for prime time?

Autori
Delalić, Điđi ; Prkačin, Ingrid

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, pp prezentacija, stručni

Skup
International Conference on Extracorporeal Organ Support

Mjesto i datum
Zagreb, Hrvatska, 04.05.2023. - 06.05.2023

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Recenziran

Ključne riječi
Cardiopulmonary Resuscitation ; Emergency Medicine ; Extracorporeal Membrane Oxygenation

Sažetak
Introduction Extracorporeal Cardiopulmonary Resuscitation (eCPR) is a relatively novel method of performing cardiopulmonary resuscitation (CPR). The central idea of eCPR is offloading the circulatory and respiratory function performed by the heart and lungs to extracorporeal support, namely venoarterial extracorporeal membrane oxygenation (VA-ECMO), while the resuscitationist attempts to reverse the causes of cardiac and pulmonary failure or injury. This paper aims to provide a review of the literature regarding eCPR, its benefits and potential flaws. Materials and methods A search of the literature was performed using the MEDLINE, Scopus, Web of Science and Google Scholar databases, using the keywords “eCPR”, “extracorporeal CPR” and “extracorporeal resuscitation”. Papers were excluded if they were not original research or described the use of VA- ECMO in contexts other than cardiopulmonary resuscitation. Results The search yielded a rather large number of observational trials, either prospective or retrospective, reporting on the survival rates of patients with either in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) treated with eCPR protocols and three randomized control trials (RCTs) comparing eCPR to conventional CPR (cCPR) in patients with OHCA. In patients with IHCA refractory to cPR, the reported survival rates with eCPR vary between 20% and 40%. In patients with OHCA refractory to cCPR, observational studies report similar survival rates with eCPR, varying between 20.5% and 38.5%, while survival rates with favorable neurologic outcome range from 12.3% to 18%. The three RCTs comparing eCPR to cCPR report discordant results: the ARREST trials reports a 36% increase in survival with eCPR (43% vs 7%), while the INCEPTION trial reports no statistically significant difference in survival with a favorable neurologic outcome (20% vs 16%, p=0.52), and the Prague trial was terminated early for futility. It is worth noting that there was no established pre-hospital or hospital eCPR protocol in the INCEPTION study. Also, the time elapsed from OHCA to establishing flow on ECMO was 74 minutes in the INCEPTION study and 56 minutes in the ARREST study. There are also studies showing statistically significant improvement in OHCA to ECMO flow times and a nonsignificant trend towards increased survival with eCPR following specialized simulation training and implementation of an institution-wide eCPR protocol. Conclusion While the data from published RCTs comparing eCPR to cCPR is conflicting, the observational data shows acceptable and encouraging survival rates with eCPR. There is wide variation in survival rates in the aforementioned data, that could be explained by variations in institutional protocols, caseloads, level of staff training and experience, time from OHCA to establishing flow on ECMO etc. More data from larger RCTs is necessary to provide a definitive answer regarding the benefit of eCPR compared to cCPR, however factors like time to establishing flow, patient selection and existence of institutional protocol seem to be the main predictors of eCPR success rates.

Izvorni jezik
Engleski

Znanstvena područja
Biotehnologija u biomedicini (prirodno područje, biomedicina i zdravstvo, biotehničko područje)

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