The document discusses the deployment of extracorporeal membrane oxygenation (ECMO) during cardiac arrest, highlighting its potential advantages over conventional CPR, particularly in cases of refractory cardiac arrest. It summarizes findings from various studies, showing survival rates and outcomes associated with ECMO compared to traditional methods, noting the importance of timely intervention and system logistics. Overall, the analysis suggests that ECMO can lead to favorable outcomes in selected patients, although further research is still needed.

1. Peter McCanny

2.  ……Rapid deployment of VA-ECMO during cardiac arrest,
when conventional CPR has failed to provide return of
spontaneous circulation (ROSC)……
 ……or when repetitive arrests occur without sustained
ROSC……
 ECMO for low output cardiac states

5.  37yo massive PE post-op pelvic surgery
 ‘Temporary CPB provided 15mins of circulatory
support while removal of bilateral pulmonary emboli
was accomplished’

6.  ‘A battery- powered portable cardiopulmonary bypass machine
has been used in 39 patients whose condition precluded
transport to the operating room……’
 ‘……successfully placed on CPB at the bedside within 15mins of
cardiac arrest using femoral artery and femoral vein
cannulation’

8.  No RCT comparing ECPR with conventional CPR (CCPR)
 Limited to observational studies, case series
 Propensity- matched modelling to compare ECPR with CCPR
 Recent systematic review and meta-analysis

9. Fagnoul D, Combes A, De Backer D. Extracorporeal cardiopulmonary resuscitation.
Curr Opin Crit Care. 2014 Jun;20(3):259-65.

10.  3 year prospective observational study (Taiwan 2004-2006)
 IHCA >10mins, deemed likely cardiac origin
 All rhythms included
 Primary outcome: survival to hospital D/C
 Secondary outcomes: 30-day, 1-year survival, rate of ROSC
 Propensity matching to compare ECPR vs CCPR

12.  Retrospective 2003-2009, single centre (Korea)
 Primary outcome: survival to D/C with CPC 1-2
 85 patients ECPR vs 321 patients CCPR
 Propensity matched 60 pairs

14. Fagnoul D, Combes A, De Backer D. Extracorporeal cardiopulmonary resuscitation.
Curr Opin Crit Care. 2014 Jun;20(3):259-65.

15.  Retrospective, multicentre cohort study (Japan 2004- 2011)
 Refractory cardiac arrest (>20mins) due to ACS
 ECPR combined with PCI
 86 patients total
 42 OOHCA patients, (29 PCI)
 30 day survival with favourable neuro outcome 14% (21% PCI
group)

16.  Retrospective review (Berlin 2010-2011)
 ECPR for refractory OOHCA
 Aim: to identify predictors of mortality in OOHCA ECPR
 Mechanical chest compression not used
 ECPR in cath lab, followed by Angiography
 28 patients

17.  30 day survival rate of 39% (72% survivors had CPC<2)
 Only predictor of survival was door to ECMO implantation
time

18. • 35 OOHCA patients
• 28% Survival to hospital D/C

19.  1583 studies screened
 10 studies (with propensity- based analysis available)

23. 7 patients: 1 survived, 3 brain dead
Cannulation time: 22 mins (+/- 6)
Time to ECMO flow: 57 mins (+/- 21)

24. 26 patients
14/26 (54%) survival to D/C with good neuro outcome
OOHCA survival 3/9 (33%) vs IHCA survival 9/15 (60%)

25.  Retrospective review of outcomes for ECPR cases to date.
 Patients identified from ECMO databases in SVH and RPA.
 Data gathered from medical charts, databases, and local IT systems:
- Patient demographics
- Cardiac arrest details (initial rhythm, downtime etc…)
- ECMO details (setting, cannulation, complications, duration..)
- Echo and Cath lab findings
- Intervention details (PCI, CABG, VAD, HTx)
- Outcomes and follow-up data

26.  September 2009- January 2016
 42 patients
 37 included for analysis
 Median age 53yrs (17- 70)
 73% male
 SVH: n= 23 (62%) RPA: n= 14 (38%)

27. Overall (%)
Predictor of Mortality
(p- value)
Initial rhythm VT 19 (51%) 0.25
VF 1 (3%)
PEA 14 (38%)
Asystole 3 (8%)
Aetiology ACS 11 (30%) 0.79
PE 5 (14%)
Arrhythmia 3 (8%)
Other * 18 (49%)
Location IHCA 25 (68%) 0.87
OOHCA 12 (32%)
Time to ECMO flow
(minutes) 52 (+/- 28) 0.42

28. Number of patients
Coronary vasospasm 1
Overdose/ toxins 2
Myocarditis 1
Chemo- related cardiomyopathy 1
Congenital heart disease 1
Hyperacute rejection (post-CTx) 1
LVAD failure 1
Hypothermia 1
Sepsis 1
Tamponade 1
TAVI deployment 2
Unclear 3

29. 0
5
10
15
20
25
Angio PCI CABG
INTERVENTIONS
54%
24%
3%

30. Duration in days
ECMO run 4.1 (+/- 3.9)
ICU stay 12.3 (+/- 11)
Hospital stay 20.1 (+/- 19)

31. Number of patients (%) Predictor of mortality
(p- value)
Bleeding event 17 (46%) 0.48
Major bleeding (BARC 3-5) 14 (38%) 0.44
DVT 3 (8%) 0.23
PE 1 (3%) 0.3
Backflow clot 2 (5%) 0.52
Limb ischaemia 7 (19%) 0.63
Haemolysis 1 (3%) 0.46
CVA (embolic) 1 (3%) 0.46

32. No. of patients (%)
OOHCA survival 4 (33%)
IHCA survival 9 (36%)
Survival to ICU Discharge 15 (40%)
Survival to Hospital Discharge 13 (35%)

33.  All survivors (13/37) discharged CPC 1/2

34. Odds ratio (95% CI) Overall p-value
Pre- ECMO lactate 1.35 (1.06- 1.73) 0.016
Collapse to ECMO flow
<60 mins 0.33 (0.06- 1.88) 0.17

35. ECPR for refractory cardiac arrest:
 ECPR outcomes favourable vs conventional CPR
 Data gathered from centres with experience and expertise
 Development of ‘well- oiled’ systems and protocols crucial to
achieve good outcome – Logistics are crucial
 If you’re going to do, make sure you do it well