ECPR in 2020 ?

Abstract

Prolonged cardiac arrest is associated with poor return to circulation (ROSC) and poor neurologic outcome. Cardiopulmonary resuscitation assisted by veno arterial ECMO, or eCPR, has been suggested for these conditions. In this review, we will cover the potential interest and limitations of eCPR both in intrahospital (iHCA) and out-of-hospital (oHCA) cardiac arrest. In iHCA, eCPR seems to improve the outcome of patients with witnessed cardiac arrest and in whom cardiopulmonary resuscitation is initiated without delay (short no-flow time), provided of course that these patients do not suffer terminal illness. Accordingly, eCPR seems to be a reasonable option in selected patients with iHCA, when the center has the facility to insert VA ECMO. In oHCA, the results of eCPR are more balanced, and depend on the duration of low-flow time. When low-flow time is shorter than 45-60 min, eCPR is associated with survival rates around 20-30%, but survival rates drop dramatically when low-flow exceeds 60 min. It sounds thus reasonable to apply eCPR in patients with witnessed oHCA as long as the delay between cardiac arrest and ECMO run is expected to be shorter than 45-60 min.