Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO)

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• 作者：Joseph E. Tonna^a ; ^b ; ^{joseph.tonna@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Nicholas J. Johnson^c ; ^{nickjjohnson@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; John Greenwood^d ; ^{johncgreenwood@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; David F. Gaieski^e ; ^{david.gaieski@jefferson.edu" class="auth_mail" title="E-mail the corresponding author} ; Zachary Shinar^f ; ^{zshinar@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Joseph M. Bellezo^g ; ^{emergency.md@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Lance Becker^h ; ^{lance.becker@nshs.edu" class="auth_mail" title="E-mail the corresponding author} ; Atman P. Shahⁱ ; ^{ashah@bsd.uchicago.edu" class="auth_mail" title="E-mail the corresponding author} ; Scott T. Youngquist^b ; ^j ; ^{scott.youngquist@utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Michael P. Mallin^b ; ^{michael.mallin@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; James Franklin Fair III^b ; ^{James.Fair@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Kyle J. Gunnerson^k ; ^{kgunners@med.umich.edu" class="auth_mail" title="E-mail the corresponding author} ; Cindy Weng^l ; ^{cindy.weng@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; Stephen McKellar^a ; ^{stephen.mckellar@hsc.utah.edu" class="auth_mail" title="E-mail the corresponding author} ; for the Extracorporeal REsuscitation ConsorTium (ERECT) Research Group
• 关键词：Extracorporeal cardiopulmonary resuscitation&mdash ; eCPR ; Emergency Department extracorporeal membrane oxygenation&mdash ; ED ECMO ; Out-of-hospital cardiac arrest&mdash ; OHCA ; In-Hospital Cardiac Arrest&mdash ; IHCA ; Program characteristics ; Extracorporeal life support&mdash ; ECLS
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：107
• 期：Complete
• 页码：38-46
• 全文大小：1022 K

文摘

To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department.

Methods

We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel.

Results

Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow^®. Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (>85%) involve CT surgeons, perfusionists, and pharmacists.

Conclusions

Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable.