Extracorporeal cardiopulmonary resuscitation as a standard of care in the future: a literature review [version 1; peer review: awaiting peer review]

• Published in: F1000 research Vol. 12; p. 1149
• Main Authors: Patel, Vashistha, Patel, Shreya, Saab, Rayan, Prudhvi, Kalyan, Cobia, Miles, Rogers, Allison, Cole, Alanna
• Format: Journal Article
• Language: English
• Published: 2023
• Subjects: ECPR; ECMO; in-hospital cardiac arrest; extracorporeal life support; extracorporeal cardiopulmonary resuscitation; out-of-hospital cardiac arrest
• ISSN: 2046-1402; 2046-1402
• DOI: 10.12688/f1000research.137449.1

Background: The use of extracorporeal cardiopulmonary resuscitation (ECPR) is limited generally to situations where traditional CPR failed to restore a patient's heart rhythm. Although ECPR is not regarded as the standard of care for cardiac arrest patients, it might be a more effective treatment for some forms of cardiac arrest. This literature review explores the efficacy of ECPR as a potential standard of care for cardiac arrest in the future. Methods: English language publications fulfilling eligibility criteria from 2010 to 2023 were found through a literature search using four electronic databases (PubMed, Google Scholar, Cochrane, and IEEE Explore). Articles were included in this literature review for fulfilling following criteria: empirical primary studies evaluating ECPR in human subjects with either IHCA or OHCA; articles published in English between 2010 and 2023; articles exploring ECPR in cardiac arrest across all ages of patients. Results: 12 studies out of 1,092 search results met the inclusion criteria for data extraction and synthesis. Data extracted included the efficacy of ECPR in both IHCA and OHCA patients based on the PICO framework. The quality of study done by NOS (Newcastle-Ottawa Quality Assessment Scale for Cohort Studies) resulted in three studies with moderate quality while nine were of high quality. Conclusions:  ECPR was associated with neurologically intact survival with favorable neurological outcomes compared to a standard CRP for cardiac arrest patients. This study also demonstrates that, at the moment, ECPR is the most successful in centers with a well-trained multidisciplinary ECMO team of experts. On the other hand, cardiac arrest patients in semi-rural areas and underdeveloped locations are likely to benefit less from ECPR interventions due to the lack of necessary ECPR expertise and infrastructure. Those individuals eligible for ECPR benefit from better neurological outcomes and associated higher survival rates.