New 2015 ECPR Recommendations

New 2015 ECPR recommendations can be found buried in the 2015 American Heart Association guidelines for cardiopulmonary resuscitation.

The recommendations are broken down into 3 primary age groups; Neonatal, Pediatric, Adult. Then further distinguished by In Hospital Cardiac Arrest (IHCA) and Out-of-Hospital Cardiac Arrest (OHCA).

Overall general recommendations still state that there is insufficient evidence to recommend ROUTINE use of ECPR across the board.  However, use of ECPR in settings where the technology is readily available and can be rapidly implemented may be considered for “select cardiac arrest patients for whom the suspected etiology of the cardiac arrest is potentially reversible during a limited period of mechanical cardiorespiratory support.”

Interestingly, there was evidence of improved outcome for the Adult OHCA group.  According to the report, “The use of extracorporeal CPR (ECPR) may allow providers additional time to treat reversible underlying causes of cardiac arrest (eg, acute coronary artery occlusion, pulmonary embolism, refractory ventricular fibrillation, profound hypothermia, cardiac injury, myocarditis, cardiomyopathy, congestive heart failure, drug intoxication) or serve as a bridge for left ventricular assist device implantation or cardiac transplant.”  The evidence indicated improved neurologically intact survival rates for the Adult out-of-hospital cardiac arrest patients supported with ECPR compared to conventional CPR alone.   This may lead to an even more rapidly and wider expansion of the use of ECMO in Emergency Departments across the United States.

Full 2015 AHA Guidelines can be found in the November issue of CIRCULATION

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