HWN Suggests

The Race to Reinvent CPR

ECPR by itself doesn’t actually cure anything. But by providing fresh blood flow to the brain and other organs, it lets the body rest and gives doctors time to fix the underlying problem, if it’s fixable. Patients whose hearts are in a rhythm that’s conducive to being shocked with a defibrillator, like Sauer’s chaotic pattern, fare much better. That’s because they usually have a primary heart problem that can be repaired. After patients are hooked up to ECMO, angiograms of their hearts are typically performed to determine whether they have clogged arteries — as about 85 percent do. In Sauer’s case, Yannopoulos found a blockage in his largest heart vessel, the left anterior descending artery,…

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 Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR

Have you ever pondered whether all the work over ECPR was worth it? Even if you did save a few patients, does this really make sense from a societal standpoint? Am I giving up my life on a project where my efforts could be better elsewhere?

Articles of Interest

Cardiac arrest kills nearly 9 in 10 victims—we’re helping people beat those odds

Today, when a cardiac arrest victim's heart stops, if they're not inside a hospital, the chance of survival is less than 10 percent. The new ECPR alert is changing that.

ECPR can bring people back to life. Can it save more lives than CPR?

Only certain patients meet the criteria for ECPR, which is also highly invasive, not widely available, and resource-intensive.

ECPR evidence – a historical journey

The rationale for ECPR is to restore adequate organ perfusion and gas exchange. This then enables the safe provision of any interventions necessary to restore intrinsic circulation. Defining the optimal time is a challenge – too early and patients may not have required ECPR but are still exposed to the risks and too late and any benefit may be negated. The ASAIO guidelines recommend preparing to cannulate after 20 minutes of failed resuscitation, with the goal to establish VA ECMO within 60 minutes of cardiac arrest. This, however, is not supported by high quality randomised controlled trials.

ECPR—extracorporeal cardiopulmonary resuscitation

Even though the ECPR practice is several years old, various unanswered questions need to be answered by structured studies. Several randomized control trials are currently in progress to answer some of the questions.

Extracorporeal Cardiopulmonary Resuscitation for Cardiac Arrest

Does extracorporeal cardiopulmonary resuscitation (eCPR) improve survival rates? This Concise Critical Appraisal reviews a study that sought to determine whether patients who received eCPR after out-of-hospital cardiac arrest had a favorable neurologic outcome at 30 days compared to those who received conventional CPR.

Staying Alive: Timing and Indications for ECPR

Survival in refractory CA over 30 minutes drops to approximately 0-10%. With ECPR, survival with good neurological outcome range can increase to around 10-40%, even up to 30-60mins. There are no randomized controlled trials comparing conventional to ECPR, but observational studies and systematic reviews of selective patients have found ECPR to be more effective than conventional CPR

The Resus Tracks: A Chat with Domagoj Damjanovic!

So in this one, DOmagoj and I discuss a bunch of resus topics, from eCPR to tissue oximetry. I’m really jealous of the fact that he does prehospital work with an ECMO van!!! …and with cool gear and of course, POCUS!

What to Know About Life-Saving ECPR

A new approach to reviving victims of cardiac arrest has a higher rate of success than conventional CPR.

Will Mobile ECPR Change How EMS Treats Cardiac Arrest?

No one is busier dying than a patient in refractory ventricular fibrillation (RVF). These patients have exasperated EMS personnel for decades, and they, sadly, usually die. The treatment traditionally has been to administer ACLS for 30–45 minutes, and the lucky few who get a return of spontaneous circulation (ROSC) get admitted. The survival rate using this approach has been around 8%. But, with the advent of adult, extracorporeal membrane oxygenation (ECMO), the approach to these patients may be changing.