ICU · resuscitation

Extracorporeal Cardiopulmonary Resuscitation (ECPR)

Also known as ECPR · Extracorporeal CPR · E-CPR · ECMO during cardiac arrest · VA-ECMO for cardiac arrest · Cannulation during CPR · Refractory cardiac arrest ECMO

Extracorporeal cardiopulmonary resuscitation (ECPR) — the rapid deployment of venoarterial extracorporeal membrane oxygenation (VA-ECMO) during ongoing CPR in patients with refractory cardiac arrest (failure of conventional ACLS). Indications: witnessed in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) with initial shockable rhythm (VF/pVT), no-flow time <5 minutes (unwitnessed/arrest to CPR), low-flow time (CPR duration) <60 minutes, age <70 (relative), no severe comorbidity, end-tidal CO2 10 mmHg during CPR (suggesting ongoing perfusion). Cannulation: percutaneous femoral arterial + femoral venous (Seldinger technique — by intensivist, cardiologist, or perfusionist) during ongoing mechanical CPR (LUCAS/AutoPulse). Flow: 3-5 L/min within 10-15 minutes of team activation. Post-ECPR: targeted temperature management (32-36 degrees C), percutaneous coronary intervention (if ACS cause), continuous EEG (seizure detection), lung-protective ventilation, anticoagulation (heparin — target ACT 1.5x baseline). Outcomes: IHCA 30-40% survival to discharge (good neurological outcome); OHCA 20-30% survival (selected patients). Complications: bleeding (30-50% — vascular, intracranial, GI), thrombosis (circuit), limb ischaemia (femoral arterial cannulation), haemolysis, AKI, brain death. Contraindications: asystole as initial rhythm, unwitnessed arrest, known terminal illness, severe aortic regurgitation, aortic dissection, uncontrolled bleeding.