Designing an Extracorporeal Cardiopulmonary Resuscitation Protocol: It Is Time to Address Quality

Extracorporeal cardiopulmonary resuscitation (ECPR) refers to the use of temporary mechanical support as an adjunct to standard CPR in patients with cardiovascular collapse. Although it is a relatively recent practice, there have been nearly 5,000 cases of ECPR to-date according to the extracorporeal life support organization (ELSO) registry.¹ As the use of ECPR increases, the remaining challenge is to ensure the quality of ECPR is commensurately improving. The motivation is both clinical and financial. Clinically, although ECPR has undoubtedly led to meaningful extension of life in many cases, as a bridge to recovery, transplantation or a durable device, there is clear room for improvement in utilization of ECPR as only 20–32% of patients under current standard practices have been shown to survive to discharge.^1–4 Inappropriate or suboptimal initiation of ECPR can lead to difficult medical and ethical conundrums that may adversely affect the patient, families, and even the clinicians. Financially, the Center for Medicare Services (CMS) recently announced a decision to reduce the reimbursement amount for peripheral extracorporeal membrane oxygenation (ECMO)—a cannulation strategy almost always utilized in ECPR—incentivizing a more careful and judicious use of this technology.⁵