Roger Pye is a world leading ECMO specialist. This talk on starting ECMO during CPR resuscitation is serious and backed up by some extraordinary cases. Roger presents his experience and the literature on this topic. The presentation can be heard on wwwintensivecarenetwork.com.

3. VA ECMO
During CPR

4. VA ECMO
During CPR
Go Hard and Go Fast !!

6. History of Resuscitation

13. VA ECMO During CPR

14. VA ECMO During CPR
The Final Frontier of Resuscitation

15. VA ECMO During CPR
The Final Frontier of Resuscitation
Or
Just Blowing Smoke Up Your Arse

23. • 330 Beds
• Heart-Lung Tx & VAD Unit
• 20 Bed ICU

25. • 233 ECMO Cases since 2004
• 30 per year last 3years

26. • 12 ECMO-CPR Cases
• Last Case over 1 year ago

28. Witnessed ED Arrest

34. Cath Lab Arrest

42. Out-of- Hospital
Arrest

48. Pre-Arrest

56. The Literature

57. Conventional CPR

58. Conventional CPR
Out-of-Hospital Cardiac Arrest
Approx. 4-15% STHD if VT/VF

59. Conventional CPR

60. Conventional CPR
In-Hospital Cardiac Arrest
10-15% STHD
Survival Drop-off >30min CPR

61. Conventional CPR
In-Hospital Cardiac Arrest
10-15% STHD
Survival Drop-off >30min CPR

62. ECMO During CPR

63. No RCTs

64. No RCTs
Most Single Center
Observational Studies

66. Godfather of ECMO

67. Bob Bartlett
Ann Arbor, Michigan, USA

68. Acad Emerg Med 1999
• 25 Cases over 7 years
• IH & OH Arrests

70. Acad Emerg Med 1999
• Most Perc. Cannulations
- took 10-30min
• 1 Death both Cann. Arterial

71. Acad Emerg Med 1999
• 28% (7) Survive to Discharge
• 16% (4) VADs
• 3 OHCA all died

72. Acad Emerg Med 1999
Survival more likely if:

73. Acad Emerg Med 1999
Survival more likely if:
• Arrest during assessment & CPR < 40min
• Shorter duration on ECMO < 3days
• Correctable underlying Disease: PE , CAD

74. Jaski et al

75. Jaski et al
San Diego Cardiac Center

76. Jaski et al
San Diego Cardiac Center
• Arrest & Pre-arrest
• Percutaneous cannulation(Dr) & ICU Nursing
• 127 Arrests
• Age: 40 - 74

77. Jaski et al
San Diego Cardiac Center
• 26% Survived 30+ days
with Median Survival 9.5 years

78. Jaski et al
San Diego Cardiac Center
• 26% Survived 30+ days
with Median Survival 9.5 years
• No Change over 20 years

79. Jaski et al
San Diego Cardiac Center
• Cath Lab Arrests did better

81. Jaski et al
San Diego Cardiac Center
• Cath Lab Arrests did better
• VT/VF initial Rhythm better
• Unwitnessed all died

82. • Pre-arrest do the best

83. ELSO Database

84. Ann Thor Surg 2009
Harvard Medical School, Boston
ELSO Database
1992 - 2007

85. ELSO Database
297 Adult Cases

86. ELSO Database

87. ELSO Database
• Mean Age = 52
• 27% Survive to Discharge

88. ELSO Database
• Mean Age = 52
• 27% Survive to Discharge
• No Change over 15 years

89. ELSO Database
• 21% “Brain Dead”
• Dialysis = 2x Mortality

90. Chen et al

91. Chen et al
National Taiwan University Hospital
Taipei

92. Chen et al
2,000 beds

93. Chen et al
JACC 2003

94. Chen et al
JACC 2003
Lancet 2008

95. Chen et al
• Witnessed Arrest CPR>10min
• 18 - 75 years

96. Chen et al
• Witnessed Arrest CPR>10min
• 18 - 75 years
• 2003: 57 Cases over 6 years

97. Chen et al
• Witnessed Arrest CPR>10min
• 18 - 75 years
• 2003: 57 Cases over 6 years
• 2008: 59 Cases over 3 years

98. Chen et al
• 1/3 Survived to Discharge
• 2008: 14/15 Good Brain
• ECMO out to 60min

99. Chen et al
• 1/3 Survived to Discharge
• 2008: 14/15 Good Brain
• ECMO out to 60min

100. Chen et al

101. Chen et al
• 1/3 Survived to Discharge
• 2008: 14/15 Good Brain
• ECMO out to 60min
• Renal Failure = Poor Prognosis

102. Shin et al

103. Shin et al
Samsung Medical Center
Seoul, Korea

104. Shin et al
1,951 beds

105. Shin et al

106. Shin et al
• Age: 18 – 80
• 24/7 Service
• 85 Cases over 6 years

107. Shin et al
• 1/3 Survive to Discharge
• 80% Survivor Brains Acceptable
• 6% Failure to Cannulate

108. Le Guen et al

109. Le Guen et al
La Pitie-Salpetriere, Paris, France

110. Le Guen et al
La Pitie-Salpetriere, Paris, France
National Non-Beating Heart Donor – VA ECMO

111. Le Guen et al
La Pitie-Salpetriere, Paris, France
National Non-Beating Heart Donor – VA ECMO
24/7 Mobile VA ECMO

112. Le Guen et al
La Pitie-Salpetriere, Paris, France
Crit Care 2011

113. Le Guen et al
• 51 Cases over 32months
• 4% (2) Survived 28 days, Brain OK

114. Le Guen et al
Cause of Death:
• MSOF 45%
• Bleeding 14%
• Brain Death 20%

116. The Bottom Line

127. ECMO During
Witnessed Cardiac Arrest
• Decide Early into Arrest
• 1/3 Survive to Discharge (2x CPR)
• 80% with OK Brain
• Median Survival 9-10 years

128. ECMO During
Witnessed Cardiac Arrest
• Decide Early into Arrest
• 1/3 Survive to Discharge (2x CPR)
• 80% with OK Brain
• Median Survival 9-10 years

129. ECMO During
Witnessed Cardiac Arrest
• Cath Lab Good Spot to Arrest
• ECMO Decision 5-7 days
• Renal Failure is Bad

130. ECMO During
Witnessed Cardiac Arrest
AGE ??

131. AGE ??

132. AGE ??
>75 do just as well

133. AGE ??
>75 do just as well
???

135. Resources