Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

Darryl Abrams; Graeme MacLaren; Roberto Lorusso; Susanna Price; Demetris Yannopoulos; Leen Vercaemst; Jan Bělohlávek; Fabio S. Taccone; Nadia Aissaoui; Kiran Shekar; A. Reshad Garan; Nir Uriel; Joseph E. Tonna; Jae Seung Jung; Koji Takeda; Yih Sharng Chen; Arthur S. Slutsky; Alain Combes; Daniel Brodie

doi:10.1007/s00134-021-06514-y

Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

Darryl Abrams, Graeme MacLaren, Roberto Lorusso, Susanna Price, Demetris Yannopoulos, Leen Vercaemst, Jan Bělohlávek, Fabio S. Taccone, Nadia Aissaoui, Kiran Shekar, A. Reshad Garan, Nir Uriel, Joseph E. Tonna, Jae Seung Jung, Koji Takeda, Yih Sharng Chen, Arthur S. Slutsky, Alain Combes, Daniel Brodie

Medicine - Cardiology Division

Research output: Contribution to journal › Review article › peer-review

25 Scopus citations

Abstract

Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.

Original language	English (US)
Journal	Intensive Care Medicine
Volume	48
Issue number	1
Early online date	Sep 10 2021
DOIs	https://doi.org/10.1007/s00134-021-06514-y
State	Published - Sep 10 2021

Bibliographical note

Funding Information:
DA reports serving as an at-large member of the Steering Committee for the Extracorporeal Life Support Organization (ELSO). GM reports serving as a member of the board of directors for ELSO. RL reports personal fees from Medtronic and LivaNova, outside the submitted work; member of advisory boards of Eurosets and PulseCath; advisor to the board of directors of ELSO and a past president of the European chapter of ELSO (EuroELSO). DY receives NIH grant support for resuscitation and ECPR and a Helmsley Philanthropic Trust grant for Mobile ECPR Implementation. LV receives consulting fees from Medtronic, outside the submitted work. JB is the current president of EuroELSO. FST reports personal fees from BARD, outside the submitted work. KS receives research support from Metro North Hospital and Health Service, outside the submitted work, and is the research lead of the ELSO Education Task Force (ECMOed) and member of the steering and educational committees for the Asia–Pacific chapter of ELSO (APELSO). ARG is a member of the advisory board for Abbott. JET was supported by a career development award (K23HL141596) from the National Heart, Lung, And Blood Institute (NHLBI) of the National Institutes of Health (NIH), received speakers fees and travel compensation from LivaNova relevant to cardiac arrest, outside the submitted work, speaker fees and travel compensation from Philips Healthcare, outside the submitted work, and is Chair of the Scientific Oversight Committee for ELSO. JSJ is an at-large member of the Steering Committee for the Asia–Pacific chapter of APELSO. YSC is the past chair and current conference committee chair of APELSO. ASS and AC report grants and personal fees from MAQUET, Xenios, and Baxter. AC was a past president of EuroELSO. DB receives research support from ALung Technologies, has been on the medical advisory boards for Baxter, Abiomed, Xenios, and Hemovent, and is the President-elect and member of the board of directors for ELSO. SP, NA, KT, and NU have no disclosures to report.

Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

Cardiac arrest
Extracorporeal cardiopulmonary resuscitation
Extracorporeal membrane oxygenation
IHCA
OHCA

Publisher link

10.1007/s00134-021-06514-y

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Abrams, D., MacLaren, G., Lorusso, R., Price, S., Yannopoulos, D., Vercaemst, L., Bělohlávek, J., Taccone, F. S., Aissaoui, N., Shekar, K., Garan, A. R., Uriel, N., Tonna, J. E., Jung, J. S., Takeda, K., Chen, Y. S., Slutsky, A. S., Combes, A., & Brodie, D. (2021). Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Medicine, 48(1). https://doi.org/10.1007/s00134-021-06514-y

Abrams, D, MacLaren, G, Lorusso, R, Price, S, Yannopoulos, D, Vercaemst, L, Bělohlávek, J, Taccone, FS, Aissaoui, N, Shekar, K, Garan, AR, Uriel, N, Tonna, JE, Jung, JS, Takeda, K, Chen, YS, Slutsky, AS, Combes, A & Brodie, D 2021, 'Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications', Intensive Care Medicine, vol. 48, no. 1. https://doi.org/10.1007/s00134-021-06514-y

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abstract = "Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.",

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N2 - Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.

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Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

Abstract

Bibliographical note

Keywords

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