Bertini Pietro, Sangalli Fabio, Meani Paolo, Marabotti Alberto, Rubino Antonio, Scolletta Sabino, Ajello Valentina, Aloisio Tommaso, Baiocchi Massimo, Monaco Fabrizio, Ranucci Marco, Santonocito Cristina, Silvetti Simona, Sanfilippo Filippo, Paternoster Gianluca
Department of Anesthesia and Intensive Care Medicine, Casa di Cura Privata San Rossore, 56122 Pisa, Italy.
Department of Anaesthesia and Intensive Care, ASST Valtellina e Alto Lario, University of Milano-Bicocca, 23020 Sondrio, Italy.
Medicina (Kaunas). 2024 Dec 2;60(12):1979. doi: 10.3390/medicina60121979.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a complex, life-saving procedure that uses mechanical support for patients with refractory cardiac arrest, representing the pinnacle of extracorporeal membrane oxygenation (ECMO) applications. Effective ECPR requires precise patient selection, rapid mobilization of a multidisciplinary team, and skilled cannulation techniques. Establishing a program necessitates a cohesive ECMO system that promotes interdisciplinary collaboration, which is essential for managing acute cardiogenic shock and severe pulmonary failure. ECPR is suited for selected patients, emphasizing the need to optimize every step of cardiac arrest management-from public education to advanced post-resuscitation care. The flexibility of ECMO teams allows them to manage various emergencies such as cardiogenic shock, massive pulmonary embolism, and severe asthma, showcasing the program's adaptability. Launching an ECPR program involves addressing logistical, financial, and organizational challenges. This includes gaining administrative approval, assembling a diverse team, and crafting detailed protocols and training regimens. The development process entails organizing teams, refining protocols, and training extensively to ensure operational readiness. A systematic approach to building an ECPR program involves establishing a team, defining patient selection criteria, and evaluating caseloads. Critical elements like patient transport protocols and anticoagulation management are vital for the program's success. In conclusion, initiating an ECPR program demands thorough planning, collaborative effort across specialties, and ongoing evaluation to improve outcomes in critical cardiac emergencies. This guide offers practical insights to support institutions in navigating the complexities of ECPR program development and maintenance.
体外心肺复苏（ECPR）是一种复杂的救命程序，它为顽固性心脏骤停患者提供机械支持，代表了体外膜肺氧合（ECMO）应用的巅峰。有效的ECPR需要精确的患者选择、多学科团队的快速动员以及熟练的插管技术。建立一个项目需要一个有凝聚力的ECMO系统，以促进跨学科合作，这对于管理急性心源性休克和严重肺衰竭至关重要。ECPR适用于特定患者，强调需要优化心脏骤停管理的每一步——从公众教育到高级复苏后护理。ECMO团队的灵活性使他们能够管理各种紧急情况，如心源性休克、大面积肺栓塞和严重哮喘，展示了该项目的适应性。启动ECPR项目涉及应对后勤、财务和组织方面的挑战。这包括获得行政批准、组建多元化团队以及制定详细的方案和培训计划。开发过程需要组织团队、完善方案并进行广泛培训，以确保做好运营准备。建立ECPR项目的系统方法包括组建团队、定义患者选择标准以及评估病例数量。患者转运方案和抗凝管理等关键要素对项目的成功至关重要。总之，启动ECPR项目需要全面规划、各专业的协作努力以及持续评估，以改善危急心脏紧急情况的治疗结果。本指南提供了实用的见解，以支持机构应对ECPR项目开发和维护的复杂性。
