title: Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).
abstract: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department.
  
  
  
  We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel.
  
  
  
  Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow(®). Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists.
  
  
  
  Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable.
authors: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, 3C127, Salt Lake City, UT 84132, United States; Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, 1C26 SOM, Salt Lake City, UT 84132, United States. Electronic address: joseph.tonna@hsc.utah.edu.
authors: Joseph E
authors: JE
authors: Tonna
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA 98195-6522, United States. Electronic address: nickjjohnson@gmail.com.
authors: Nicholas J
authors: NJ
authors: Johnson
authors: Department of Emergency Medicine, Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Ground Ravdin, Philadelphia, PA 19104, United States. Electronic address: johncgreenwood@gmail.com.
authors: John
authors: J
authors: Greenwood
authors: Sidney Kimmel Medical College at Thomas Jefferson University, Department of Emergency Medicine, 1025 Walnut Street, 300 College Building, Philadelphia, PA 19107, United States. Electronic address: david.gaieski@jefferson.edu.
authors: David F
authors: DF
authors: Gaieski
authors: Department of Emergency Medicine, Sharpe Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, United States. Electronic address: zshinar@hotmail.com.
authors: Zachary
authors: Z
authors: Shinar
authors: Department of Emergency Medicine, Emergency Department ECMO Services, Department of Emergency Medicine, Sharpe Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, United States. Electronic address: emergency.md@gmail.com.
authors: Joseph M
authors: JM
authors: Bellezo
authors: Hofstra Northwell School of Medicine, Chairman of Emergency Medicine at Long Island Jewish Medical Center & North Shore University Hospital, 270-05 76th Ave., New Hyde Park, NY 11040, United States. Electronic address: lance.becker@nshs.edu.
authors: Lance
authors: L
authors: Becker
authors: Section of Cardiology, Adult Cardiac Catheterization Laboratory, The University of Chicago, 5841 S. Maryland Avenue, MC 6080, Chicago, IL 60637, United States. Electronic address: ashah@bsd.uchicago.edu.
authors: Atman P
authors: AP
authors: Shah
authors: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, 1C26 SOM, Salt Lake City, UT 84132, United States; Salt Lake City Fire Department, 475 300 E, Salt Lake City, UT 84111, United States. Electronic address: scott.youngquist@utah.edu.
authors: Scott T
authors: ST
authors: Youngquist
authors: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, 1C26 SOM, Salt Lake City, UT 84132, United States. Electronic address: michael.mallin@hsc.utah.edu.
authors: Michael P
authors: MP
authors: Mallin
authors: Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, 1C26 SOM, Salt Lake City, UT 84132, United States. Electronic address: James.Fair@hsc.utah.edu.
authors: James Franklin
authors: JF
authors: Fair
authors: Departments of Emergency Medicine, Anesthesiology, and Internal Medicine, Michigan Center for Integrative Research In Critical Care (MCIRCC), University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109-5303, United States. Electronic address: kgunners@med.umich.edu.
authors: Kyle J
authors: KJ
authors: Gunnerson
authors: Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, United States. Electronic address: cindy.weng@hsc.utah.edu.
authors: Cindy
authors: C
authors: Weng
authors: Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, 3C127, Salt Lake City, UT 84132, United States. Electronic address: stephen.mckellar@hsc.utah.edu.
authors: Stephen
authors: S
authors: McKellar
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015397:Program Evaluation; D012042:Registries; D014481:United States
keywords: Emergency Department extracorporeal membrane oxygenation—ED ECMO; Extracorporeal cardiopulmonary resuscitation—eCPR; Extracorporeal life support—ECLS; In-Hospital Cardiac Arrest—IHCA; Out-of-hospital cardiac arrest—OHCA; Program characteristics