Emergency physician-initiated extracorporeal cardiopulmonary resuscitation

Abstract Context Extracorporeal cardiopulmonary resuscitation (ECPR) refers to emergent percutaneous veno-arterial cardiopulmonary bypass to stabilize and provide temporary support of patients who suffer cardiopulmonary arrest. Initiation of ECPR by emergency physicians with meaningful long-term pat...

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Bibliographic Details
Published in:Resuscitation 2012-08, Vol.83 (8), p.966-970
Main Authors: Bellezzo, Joseph M, Shinar, Zack, Davis, Daniel P, Jaski, Brian E, Chillcott, Suzanne, Stahovich, Marcia, Walker, Christopher, Baradarian, Sam, Dembitsky, Walter
Format: Article
Language:English
Subjects:
Aged
Algorithms
Cardiac arrest
Cardiopulmonary Bypass
Cardiopulmonary resuscitation
Cardiopulmonary Resuscitation - methods
Cardiopulmonary support (CPS)
Emergency
Emergency department
Emergency Medicine
Emergency physician
Emergency Service, Hospital
Extracorporeal life support
Extracorporeal membrane oxygenation (ECMO)
Female
Heart Arrest - mortality
Heart Arrest - therapy
Humans
Male
Middle Aged
Observation
Patient Discharge
Resuscitation
Retrospective Studies
Shock
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Summary:Abstract Context Extracorporeal cardiopulmonary resuscitation (ECPR) refers to emergent percutaneous veno-arterial cardiopulmonary bypass to stabilize and provide temporary support of patients who suffer cardiopulmonary arrest. Initiation of ECPR by emergency physicians with meaningful long-term patient survival has not been demonstrated. Objective To determine whether emergency physicians could successfully incorporate ECPR into the resuscitation of patients who present to the emergency department (ED) with cardiopulmonary collapse refractory to traditional resuscitative efforts. Design A three-stage algorithm was developed for ED ECPR in patients meeting inclusion/exclusion criteria. We report a case series describing our experience with this algorithm over a 1-year period. Results 42 patients presented to our ED with cardiopulmonary collapse over the 1-year study period. Of these, 18 patients met inclusion/exclusion criteria for the algorithm. 8 patients were admitted to the hospital after successful ED ECPR and 5 of those patients survived to hospital discharge neurologically intact. 10 patients were not started on bypass support because either their clinical conditions improved or resuscitative efforts were terminated. Conclusion Emergency physicians can successfully incorporate ED ECPR in the resuscitation of patients who suffer acute cardiopulmonary collapse. More studies are necessary to determine the true efficacy of this therapy.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2012.01.027