Extracorporeal cardiopulmonary resuscitation.
OBJECTIVE
To discuss the role of extracorporeal membrane oxygenation (ECMO) in patients with cardiac arrest.


RESULTS
Return to spontaneous circulation dramatically decreases with the duration of cardiopulmonary resuscitation (CPR). In this context, it has been proposed to implement venoarterial ECMO in order to assist CPR (ECPR) both in inhospital cardiac arrest (IHCA) and in out-of-hospital cardiac arrest (OHCA).


CONCLUSIONS
This review highlights that ECPR is feasible for both IHCA and OHCA. In the recent series, the outcome of ECPR in IHCA is satisfactory, with survival rates good with neurologic outcome reaching the 40-50% range. All series converge in highlighting that time from cardiac arrest to ECMO flow is a critical determinant of outcome, with survival rates of 50% when initiated within 30 min of IHCA, 30% between 30 and 60 min, and 18% after 60 min. Results of ECPR in OHCA are more challenging. Recent series suggest that good outcome can be obtained in 15-20% of the patients, provided that time from arrest to ECMO is shorter than 60 min. Duration of cardiac arrest seems to be more important than location of cardiac arrest. ECPR thus seems to be a valuable option in selected cases.
aDepartment of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium bService de Réanimation Médicale, Groupe Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
David
D
Fagnoul
Alain
A
Combes
Daniel
D
De Backer
D001926:Brain Death; D016887:Cardiopulmonary Resuscitation; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use; D011379:Prognosis; D020127:Recovery of Function; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
D018696:Neuroprotective Agents