Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-volume Extracorporeal Membrane Oxygenation Center

Authors

Peter C. Michalakes, Tufts University School of Medicine, Boston, MA, 02111, USA.
Walter F. DeNino, Tufts University School of Medicine, Boston, MA, 02111, USA - Department of Cardiac Surgery, Maine Medical Center, Portland, ME, 04102, USA.
Claire B. Jara, Department of Cardiovascular Perfusion, Maine Medical Center, Portland, ME, 04102, USA.
Maxwell E. Afari, Tufts University School of Medicine, Boston, MA, 02111, USA - Department of Advanced Heart Failure and Transplant Cardiology, Maine Medical Center, Portland, ME, 04102, USA.
Bram J. Geller, Tufts University School of Medicine, Boston, MA, 02111, USA - Department of Cardiovascular Medicine, and Cardiovascular Critical Care Services, Maine Medical Center, Portland, ME, 04102, USA.

Document Type

Article

Publication Date

12-2023

Institution/Department

Cardiology; Critical Care Services

Journal Title

The journal of extra-corporeal technology

MeSH Headings

Humans; Out-of-Hospital Cardiac Arrest (therapy); Extracorporeal Membrane Oxygenation (methods); Cardiopulmonary Resuscitation (methods); Retrospective Studies

Abstract

Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging approach to cardiac arrest. We present two contrasting cases from a high-volume extracorporeal membrane oxygenation (ECMO) center (defined as greater than 30 ECMO cases per year) without a 24/7 ECPR program to highlight how to establish an ECPR program with a focus on patient selection and outcome optimization. In one case, a patient presented with cardiac arrest during initial triage for chest pain within the emergency department, and in the other case, a patient experienced an out-of-hospital cardiac arrest with prolonged no-flow and low-flow time. Despite the lack of a 24/7 ECPR program at the presenting center, both patients received an ECPR evaluation, as both patients presented while all services necessary for ECMO cannulation were available. The in-hospital cardiac arrest patient was successfully cannulated for ECMO during cardiopulmonary resuscitation and survived with few complications. The out-of-hospital cardiac arrest patient was deemed a poor candidate for ECPR and expired soon after presentation. These two cases highlight the complex decision-making in ECPR and further illustrate how to create ECPR protocols at a high-volume ECMO center before resources are available for a 24/7 ECPR program.

ISSN

0022-1058

First Page

185

Last Page

188

Recommended Citation

Michalakes PC, DeNino WF, Jara CB, Afari ME, Geller BJ. Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-volume Extracorporeal Membrane Oxygenation Center. J Extra Corpor Technol. 2023;55(4):185-188. doi:10.1051/ject/2023042