Is extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest superior compared with conventional resuscitation?

摘要

Extracorporeal cardiopulmonary resuscitation (ECPR) has first been introduced in the mid-1960s for cardiac arrests that were refractory to conventional CPR (CCPR) (1). The intention is to ensure adequate systemic blood flow to prevent end-organ failure. However, it required substantial technical and logistic improvements to adopt ECPR for regular use. Only until recently, mainly specialized tertiary care centers have employed this sophisticated and resource-consuming technique on a regular basis for in-hospital cardiac arrest and out-of-hospital cardiac arrest. The most promising results have been achieved in the neonatal and pediatric population with an almost 40% intact neurological survival to hospital discharge for in-hospital cardiac arrest (2). An emerging number of observational investigations report better survival after ECPR in adults as well—particularly for in-hospital cardiac arrest cases with rapid response times (3, 4). There might, however, be some selection bias involved as ECPR was predominantly deployed a) during daytime, b) in nonelderly male adults, who had c) witnessed arrest with d) brief CPR and e) an initially shockable rhythm. Nevertheless, ECPR does allow extension of CPR duration (5) and stabilization of hemodynamics when cardiac pump function is likely critically impaired (6).