Post-Cardiac Arrest Care in Extracorporeal Cardiopulmonary Resuscitation
Abstract
OBJECTIVES:
Extracorporeal cardiopulmonary resuscitation (ECPR) serves as a lifesaving intervention for patients experiencing refractory cardiac arrest. With its expanding usage, there’s a burgeoning focus on improving patient outcomes through optimal management in the acute phase after cannulation. This review explores systematic post-cardiac arrest management strategies, associated complications, and prognostication in ECPR patients.
DATA SOURCES:
English language articles related to post-cardiac arrest care in ECPR were retrieved from PubMed.
STUDY SELECTION:
Selection includes original research, review articles and guidelines.
DATA EXTRACTION:
Information from relevant publications was reviewed, consolidated, and formulated into a narrative review.
DATA SYNTHESIS:
We found limited data and no established clinical guidelines for post-cardiac arrest care after ECPR. In contrast to non-ECPR patients where systematic post-cardiac arrest care is shown to improve the outcomes, there is no high-quality data on this topic after ECPR. This review outlines a systematic approach, albeit limited, for ECPR care, focusing on airway/breathing and circulation as well as critical aspects of intensive care unit (ICU) care including analgesia/sedation, mechanical ventilation, early O2/CO2, and temperature goals, nutrition, fluid, imaging, and neuromonitoring strategy. We summarize common on-ECMO complications and the complex nature of prognostication and withdrawal of life-sustaining therapy in ECPR. Given conflicting outcomes in ECPR randomized controlled trials focused on pre-cannulation care, a better understanding of hemodynamic, neurological, and metabolic abnormalities and early management goals may be necessary to improve their outcomes.
CONCLUSIONS:
Effective post-cardiac arrest care during the acute phase of ECPR is paramount in optimizing patient outcomes. However, a dearth of evidence to guide specific management strategies remains, indicating the necessity for future research in this field.