Research progress on extracorporeal cardiopulmonary resuscitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Ying ¹ ,  JIANG Fuqing ² ,  GUAN Yulong ¹

1. Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
2. Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518057, Guangdong, P.R.China;

Corresponding author：

JIANG Fuqing, Email: 18501050179@126.com; GUAN Yulong, Email: guanyulong@yahoo.com

Keywords：

Cardiopulmonary resuscitation; extracorporeal cardiopulmonary resuscitation; cardiac arrest; extracorporeal membrane oxygenation; complications; review

DOI：

10.7507/1007-4848.202101033

Video：

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Abstract Full text Figures/Tables Video References Cited by

Extracorporeal cardiopulmonary resuscitation (ECPR) is a salvage therapy for patients suffering cardiac arrest refractory to conventional resuscitation, and provides circulatory support in patients who fail to achieve a sustained return of spontaneous circulation. ECPR serves as a bridge therapy that maintains organ perfusion whilst the underlying etiology of the cardiac arrest is determined and treated. Increasing recognition of the survival benefit associated with ECPR has led to increased use of ECPR during the past decade. Commonly used indications for ECPR are: age<70 years, initial rhythm of ventricular fibrillation or ventricular tachycardia, witnessed arrest, bystander cardiopulmonary resuscitation within 5 min, failure to achieve sustained return of spontaneous circulation within 15 min of beginning cardiopulmonary resuscitation. This review provides an overview of ECPR utilization, recent outcomes, risk factors, and complications of ECPR. Identifying ECPR indications, rapid deployment of extracorporeal life support equipment, and high-quality ECPR management strategies are of paramount importance to improve survival.

Citation： LIANG Ying, JIANG Fuqing, GUAN Yulong. Research progress on extracorporeal cardiopulmonary resuscitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1107-1113. doi: 10.7507/1007-4848.202101033 Copy

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6.	Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation, 2020, 141(9): e139-e596.
7.	MacLaren G, Masoumi A, Brodie D. ECPR for out-of-hospital cardiac arrest: More evidence is needed. Crit Care, 2020, 24(1): 7.
8.	Malta Hansen C, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in north Carolina, 2010-2013. JAMA, 2015, 314(3): 255-264.
9.	Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation, 2017, 112: 1-10.
10.	Thiagarajan RR, Barbaro RP, Rycus PT, et al. Extracorporeal life support organization registry international report 2016. ASAIO J, 2017, 63(1): 60-67.
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27.	Yannopoulos D, Bartos JA, Martin C, et al. Minnesota resuscitation consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation. J Am Heart Assoc, 2016, 5(6): e003732.
28.	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): 157.
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1. Shanmugasundaram M, Lotun K. Refractory out of hospital cardiac arrest. Curr Cardiol Rev, 2018, 14(2): 109-114.
2. Andersen LW, Holmberg MJ, Berg KM, et al. In-hospital cardiac arrest: A Review. JAMA, 2019, 321(12): 1200-1210.
3. Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation, 2012, 125(4): 620-637.
4. Hua W, Zhang LF, Wu YF, et al. Incidence of sudden cardiac death in China: Analysis of 4 regional populations. J Am Coll Cardiol, 2009, 54(12): 1110-1118.
5. Soar J, Maconochie I, Wyckoff MH, et al. 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: Summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation, 2019, 140(24): e826-e880.
6. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation, 2020, 141(9): e139-e596.
7. MacLaren G, Masoumi A, Brodie D. ECPR for out-of-hospital cardiac arrest: More evidence is needed. Crit Care, 2020, 24(1): 7.
8. Malta Hansen C, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in north Carolina, 2010-2013. JAMA, 2015, 314(3): 255-264.
9. Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation, 2017, 112: 1-10.
10. Thiagarajan RR, Barbaro RP, Rycus PT, et al. Extracorporeal life support organization registry international report 2016. ASAIO J, 2017, 63(1): 60-67.
11. Panchal AR, Berg KM, Hirsch KG, et al. 2019 American Heart Association focused update on advanced cardiovascular life support: Use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest: An update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019, 140(24): e881-e894.
12. Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults: JACC scientific expert panel. J Am Coll Cardiol, 2019, 73(6): 698-716.
13. Richardson ASC, Tonna JE, Nanjayya V, et al. Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus statement from the Extracorporeal Life Support Organization. ASAIO J, 2021, 67(3): 221-228.
14. Reynolds JC, Grunau BE, Rittenberger JC, et al. Association between duration of resuscitation and favorable outcome after out-of-hospital cardiac arrest: Implications for prolonging or terminating resuscitation. Circulation, 2016, 134(25): 2084-2094.
15. Le Guen M, Nicolas-Robin A, Carreira S, et al. Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care, 2011, 15(1): R29.
16. Cesana F, Avalli L, Garatti L, et al. Effects of extracorporeal cardiopulmonary resuscitation on neurological and cardiac outcome after ischaemic refractory cardiac arrest. Eur Heart J Acute Cardiovasc Care, 2018, 7(5): 432-441.
17. Reynolds JC, Frisch A, Rittenberger JC, et al. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: When should we change to novel therapies? Circulation, 2013, 128(23): 2488-2494.
18. 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(11): 877-886.
19. Kim SJ, Jung JS, Park JH, et al. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: A propensity-matched study. Crit Care, 2014, 18(5): 535.
20. Hutin A, Abu-Habsa M, Burns B, et al. Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018. Resuscitation, 2018, 130: 44-48.
21. 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(21): 1961-1971.
22. D'Arrigo S, Cacciola S, Dennis M, et al. Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis. Resuscitation, 2017, 121: 62-70.
23. Cournoyer A, Cossette S, Potter BJ, et al. Prognostic impact of the conversion to a shockable rhythm from a non-shockable rhythm for patients suffering from out-of-hospital cardiac arrest. Resuscitation, 2019, 140: 43-49.
24. Grunau B, Scheuermeyer FX, Stub D, et al. Potential candidates for a structured Canadian ECPR program for out-of-hospital cardiac arrest. CJEM, 2016, 18(6): 453-460.
25. Andersen LW, Bivens MJ, Giberson T, et al. The relationship between age and outcome in out-of-hospital cardiac arrest patients. Resuscitation, 2015, 94: 49-54.
26. Barbaro RP, Paden ML, Guner YS, et al. Pediatric extracorporeal life support organization registry international report 2016. ASAIO J, 2017, 63(4): 456-463.
27. Yannopoulos D, Bartos JA, Martin C, et al. Minnesota resuscitation consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation. J Am Heart Assoc, 2016, 5(6): e003732.
28. 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): 157.
29. 中国老年医学学会急诊医学分会, 中国老年医学学会急诊医学分会 ECMO 工作委员会. 成人体外膜肺氧合辅助心肺复苏(ECPR)实践路径. 中华急诊医学杂志, 2019, 28(10): 1197-1203.
30. 中华医学会急诊医学分会复苏学组, 成人体外心肺复苏专家共识组. 成人体外心肺复苏专家共识. 中华急诊医学杂志, 2018, 27(1): 22-29.
31. Rajan S, Wissenberg M, Folke F, et al. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response times after out-of-hospital cardiac arrest. Circulation, 2016, 134(25): 2095-2104.
32. Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: An observational study and propensity analysis. Lancet, 2008, 372(9638): 554-561.
33. Shin TG, Choi JH, Jo IJ, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation. Crit Care Med, 2011, 39(1): 1-7.
34. Meert KL, Guerguerian AM, Barbaro R, et al. Extracorporeal cardiopulmonary resuscitation: One-year survival and neurobehavioral outcome among infants and children with in-hospital cardiac arrest. Crit Care Med, 2019, 47(3): 393-402.
35. Blumenstein J, Leick J, Liebetrau C, et al. Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: A propensity-matched analysis. Eur Heart J Acute Cardiovasc Care, 2016, 5(7): 13-22.
36. Sakamoto T, Morimura N, Nagao K, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study. Resuscitation, 2014, 85(6): 762-768.
37. Tanno K, Itoh Y, Takeyama Y, et al. Utstein style study of cardiopulmonary bypass after cardiac arrest. Am J Emerg Med, 2008, 26(6): 649-654.
38. 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(10265): 1807-1816.
39. Alm-Kruse K, Sørensen G, Osbakk SA, et al. Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol. Resuscitation, 2021, 162: 35-42.
40. Sandroni C, D'Arrigo S, Callaway CW, et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: A systematic review and meta-analysis. Intensive Care Med, 2016, 42(11): 1661-1671.
41. Dalia AA, Lu SY, Villavicencio M, et al. Extracorporeal cardiopulmonary resuscitation: Outcomes and complications at a quaternary referral center. J Cardiothorac Vasc Anesth, 2020, 34(5): 1191-1194.
42. Lorusso R, Barili F, Mauro MD, et al. In-hospital neurologic complications in adult patients undergoing venoarterial extracorporeal membrane oxygenation: Results from the Extracorporeal Life Support Organization Registry. Crit Care Med, 2016, 44(10): e964-e972.
43. Massetti M, Tasle M, Le Page O, et al. Back from irreversibility: Extracorporeal life support for prolonged cardiac arrest. Ann Thorac Surg, 2005, 79(1): 178-183.
44. Thiagarajan RR, Brogan TV, Scheurer MA, et al. Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in adults. Ann Thorac Surg, 2009, 87(3): 778-785.
45. Taccone FS, Picetti E, Vincent JL. High quality targeted temperature management (TTM) after cardiac arrest. Crit Care, 2020, 24(1): 6.
46. Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S465-S482.
47. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation, 2015, 86: 88-94.
48. Burkhoff D, Sayer G, Doshi D, et al. Hemodynamics of mechanical circulatory support. J Am Coll Cardiol, 2015, 66(23): 2663-2674.
49. Otani T, Sawano H, Natsukawa T, et al. D-dimer predicts bleeding complication in out-of-hospital cardiac arrest resuscitated with ECMO. Am J Emerg Med, 2018, 36(6): 1003-1008.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress on extracorporeal cardiopulmonary resuscitation

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