title: Current and Future Status of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest.
abstract: Numerous series, propensity-matched trials, and meta-analyses suggest that appropriate use of extracorporeal cardiopulmonary resuscitation (E-CPR) for in-hospital cardiac arrest (IHCA) can be lifesaving. Even with an antecedent cardiopulmonary resuscitation (CPR) duration in excess of 45 minutes, 30-day survival with favourable neurologic outcome using E-CPR is approximately 35%-45%. Survival may be related to age, duration of CPR, or etiology. Associated complications include sepsis, renal failure, limb and neurologic complications, hemorrhage, and thrombosis. However, methodological biases-including small sample size, selection bias, publication bias, and inability to control for confounders-in these series prevent definitive conclusions. As such, the 2015 American Heart Association Advanced Cardiac Life Support guidelines update recommended E-CPR as a Level of Evidence IIb recommendation in appropriate cases. The absence of high-quality evidence presents an opportunity for clinician/scientists to generate practice-defining data through collaborative investigation and prospective trials. A multidisciplinary dialogue is required to standardize the field and promote multicentre investigation of E-CPR with data sharing and the development of a foundation for high-quality trials. The objectives of this review are to (1) provide an overview of the strengths and limitations of currently available studies investigating the use of E-CPR in patients with IHCA and highlight knowledge gaps; (2) create a framework for the standardization of terminology, clinical practice, data collection, and investigation of E-CPR for patients with IHCA that will help ensure congruence in future work in this area; and (3) propose suggestions to guide future research by the cardiovascular community to advance this important field.
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Singal
authors.affiliation: Department of Community Health Sciences, Max Rady College of Medicine, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Deepa
authors.initials: D
authors.lastname: Singal
authors.affiliation: Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bednarczyk
authors.affiliation: Department of Surgery, Montreal Heart Institute and Department of Critical Care, Hôpital du Sacré Coeur de Montréal, Université de Montréal, Québec, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.affiliation: Departments of Critical Care Medicine and Surgery, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Gurmeet
authors.initials: G
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Surgery, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.affiliation: Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Kanji
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rizwan A
authors.initials: RA
authors.lastname: Manji
authors.affiliation: Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.affiliation: London Health Sciences Centre/Western University, London Ontario, Canada.
authors.forename: A Dave
authors.initials: AD
authors.lastname: Nagpal
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000639:trends; D015199:Extracorporeal Membrane Oxygenation / Q000639:trends*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D013997:Time Factors