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Extracorporeal Cardiopulmonary Resuscitation for Out-Of-Hospital Cardiac Arrest: A Systematic Approach

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Annual Update in Intensive Care and Emergency Medicine 2023

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Extracorporeal cardiopulmonary resuscitation has been recognized as a promising therapy to restore circulation and increase survival in selected patients with refractory out-of-hospital cardiac arrest. A systematic approach is essential to achieve favorable results. In this chapter, we provide an overview of the key steps to achieve the best possible outcomes based on current evidence and the authors’ experience and highlights important gaps in knowledge that need to be addressed in future studies.

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References

  1. Gräsner JT, Herlitz J, Tjelmeland IB, et al. European Resuscitation Council Guidelines 2021: epidemiology of cardiac arrest in Europe. Resuscitation. 2021;161:61–79.

    Article  PubMed  Google Scholar 

  2. Belohlavek J, Smalcova J, Rob D, et al. Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest: a randomized clinical trial. JAMA. 2022;327:737–47.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020;396:1807–16.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Holmberg MJ, Geri G, Wiberg S, et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review. Resuscitation. 2018;131:91–100.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Abrams D, MacLaren G, Lorusso R, et al. Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Med. 2021;48:1–15.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bougouin W, Dumas F, Lamhaut L, et al. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J. 2020;41:1961–71.

    Article  PubMed  Google Scholar 

  7. Patricio D, Peluso L, Brasseur A, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care. 2019;23:1–10.

    Article  Google Scholar 

  8. Poppe M, Weiser C, Holzer M, et al. The incidence of “load&go” out-of-hospital cardiac arrest candidates for emergency department utilization of emergency extracorporeal life support: a one-year review. Resuscitation. 2015;91:131–6.

    Article  PubMed  Google Scholar 

  9. Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation. 2006;71:270–1.

    Article  PubMed  Google Scholar 

  10. Tanaka Y, Taniguchi J, Wato Y, et al. The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests. Resuscitation. 2012;83:1235–41.

    Article  PubMed  Google Scholar 

  11. Kragholm K, Wissenberg M, Mortensen RN, et al. Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest. N Engl J Med. 2017;376:1737–47.

    Article  PubMed  Google Scholar 

  12. Belohlavek J, Kucera K, Jarkovsky J, et al. Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”. J Transl Med. 2012;10:1–13.

    Article  Google Scholar 

  13. Bartos JA, Grunau B, Carlson C, et al. Improved survival with extracorporeal cardiopulmonary resuscitation despite progressive metabolic derangement associated with prolonged resuscitation. Circulation. 2020;141:877–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Soar J, Böttiger BW, Carli P, et al. European resuscitation council guidelines 2021: adult advanced life support. Resuscitation. 2021;161:115–51.

    Article  PubMed  Google Scholar 

  15. Rob D, Kavalkova P, Smalcova J, et al. Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous circulation. Resuscitation. 2022;175:133–41.

    Article  PubMed  Google Scholar 

  16. Goh AX, Seow JC, Lai MY, et al. Association of high-volume centers with survival outcomes among patients with nontraumatic out-of-hospital cardiac arrest: a systematic review and meta-analysis. JAMA Netw Open. 2022;5:e2214639.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mørk SR, Stengaard C, Linde L, et al. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. Crit Care. 2021;25:1–13.

    Article  Google Scholar 

  18. Wengenmayer T, Rombach S, Ramshorn F, et al. Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care. 2017;21:1–6.

    Article  Google Scholar 

  19. Grunau B, Kime N, Leroux B, et al. Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest. JAMA. 2020;324:1058–67.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Grunau B, Reynolds J, Scheuermeyer F, et al. Relationship between time-to-ROSC and survival in out-of-hospital cardiac arrest ECPR candidates: when is the best time to consider transport to hospital? Prehosp Emerg Care. 2016;20:615–22.

    Article  PubMed  Google Scholar 

  21. Hsu CH, Meurer WJ, Domeier R, et al. Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest (EROCA): results of a randomized feasibility trial of expedited out-of-hospital transport. Ann Emerg Med. 2021;78:92–101.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Danial P, Hajage D, Nguyen LS, et al. Percutaneous versus surgical femoro-femoral veno-arterial ECMO: a propensity score matched study. Intensive Care Med. 2018;44:2153–61.

    Article  CAS  PubMed  Google Scholar 

  23. Rob D, Smalcova J, Kovarnik T, et al. Immediate percutaneous coronary intervention in patients with refractory out of hospital cardiac arrest. Circulation. 2021;144(Suppl_2):A11324 (abst).

    Article  Google Scholar 

  24. Nikolaou NI, Netherton S, Welsford M, et al. A systematic review and meta-analysis of the effect of routine early angiography in patients with return of spontaneous circulation after Out-of-Hospital Cardiac Arrest. Resuscitation. 2021;163:28–48.

    Article  PubMed  Google Scholar 

  25. Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384:2283–94.

    Article  PubMed  Google Scholar 

  26. Rob D, Belohlávek J. The mechanical support of cardiogenic shock. Curr Opin Crit Care. 2021;27:440–6.

    Article  PubMed  Google Scholar 

  27. Cashen K, Reeder R, Dalton HJ, et al. Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation: Associations with complications, mortality and functional status among survivors. Pediatr Crit Care Med. 2018;19:245.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Spangenberg T, Schewel J, Dreher A, et al. Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest. Resuscitation. 2018;127:73–8.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to J. Bělohlávek .

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Rob, D., Bělohlávek, J. (2023). Extracorporeal Cardiopulmonary Resuscitation for Out-Of-Hospital Cardiac Arrest: A Systematic Approach. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2023. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-23005-9_22

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  • DOI: https://doi.org/10.1007/978-3-031-23005-9_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-23004-2

  • Online ISBN: 978-3-031-23005-9

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