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Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications.
Abrams, Darryl; MacLaren, Graeme; Lorusso, Roberto; Price, Susanna; Yannopoulos, Demetris; Vercaemst, Leen; Belohlávek, Jan; Taccone, Fabio S; Aissaoui, Nadia; Shekar, Kiran; Garan, A Reshad; Uriel, Nir; Tonna, Joseph E; Jung, Jae Seung; Takeda, Koji; Chen, Yih-Sharng; Slutsky, Arthur S; Combes, Alain; Brodie, Daniel.
  • Abrams D; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 622 W168th St., PH 8E, Room 101, New York, NY, 10032, USA.
  • MacLaren G; Center for Acute Respiratory Failure, Columbia University Irving Medical Center, New York, NY, USA.
  • Lorusso R; Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore.
  • Price S; Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
  • Yannopoulos D; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK.
  • Vercaemst L; National Heart and Lung Institute, Imperial College, London, UK.
  • Belohlávek J; Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
  • Taccone FS; Department of Perfusion, University Hospital Gasthuisberg, Leuven, Belgium.
  • Aissaoui N; Second Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
  • Shekar K; Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
  • Garan AR; Intensive Care Unit, APHP, Hopital Européen Georges Pompidou, Inserm U 970, Université de Paris, Paris, France.
  • Uriel N; Adult Intensive Care Services, Prince Charles Hospital, Brisbane, Australia.
  • Tonna JE; University of Queensland, Brisbane, Australia.
  • Jung JS; Bond University, Gold Coast, Australia.
  • Takeda K; Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
  • Chen YS; Division of Cardiology, Department of Medicine, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA.
  • Slutsky AS; Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA.
  • Combes A; Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA.
  • Brodie D; Department of Thoracic and Cardiovascular Surgery, Korea University Medicine, Seoul, Republic of Korea.
Intensive Care Med ; 48(1): 1-15, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1800370
ABSTRACT
Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Extracorporeal Membrane Oxygenation / Cardiopulmonary Resuscitation / Out-of-Hospital Cardiac Arrest Type of study: Controlled clinical trial / Evidence synthesis / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-021-06514-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Extracorporeal Membrane Oxygenation / Cardiopulmonary Resuscitation / Out-of-Hospital Cardiac Arrest Type of study: Controlled clinical trial / Evidence synthesis / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-021-06514-y