Cardiac arrest affects approximately 600 000 people in the US yearly and is associated with a survival rate of 10% to 12% for out-of-hospital cardiac arrests and 25% to 30% for in-hospital cardiac arrests.¹ Outcomes are particularly poor for people with cardiac arrests who are not responsive to initial treatment. Extracorporeal cardiopulmonary resuscitation (ECPR) is a newer treatment option for these patients.

ECPR consists of the implantation of venoarterial extracorporeal membrane oxygenation during cardiac arrest (Figure). Extracorporeal circulation was initially developed to facilitate blood flow and oxygen delivery to the body during operation on a nonbeating heart. Later, extracorporeal circulation was developed to promote blood flow and oxygen delivery during cardiac arrest.

During ECPR, deoxygenated blood is removed from a central vein, such as the inferior vena cava, and circulated through a membrane oxygenator where carbon dioxide is removed and oxygen is added before the blood is returned through the femoral artery into the aorta.² Blood delivery in the aorta facilitates organ perfusion, including coronary and cerebral perfusion. The application of ECPR allows the organs, such as the heart and lungs, to recover from the injury related to the cardiac arrest, providing time for reversible causes to be treated.

Rapid identification and transport of patients with cardiac arrest to a facility that can administer ECPR may facilitate survival. To be effective, ECPR must be promptly administered and requires a multidisciplinary team, substantial resources, and well-defined protocols.³ For these reasons, ECPR is typically performed in specialized centers with highly trained personnel. ECPR vascular access and cannula placement should be guided by vascular ultrasonography and fluoroscopy, although effective methods may differ among institutions.³

According to the Extracorporeal Life Support Organization registry, the survival rate for individuals who have undergone ECPR for cardiac arrest is approximately 30%.⁴ Approximately 25% of patients experience bleeding and approximately 5% experience limb ischemia distal to the femoral arterial cannula.