Purington Ella, Shaw Christopher R, Berglund Erica, Finney Bronwyn, Dellavolpe Jeffrey, Dennis Mark, Miranda Dinis Reis, Hutin Alice, Elliott Andrea M, Bartos Jason A, Hsu Cindy H, Bernardoni Brittney, Lauria Michael J, Gottula Adam L
Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
Scand J Trauma Resusc Emerg Med. 2025 Aug 7;33(1):135. doi: 10.1186/s13049-025-01448-6.
Despite advancements in care, out-of-hospital cardiac arrest has a low survival rate. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown improved outcomes in select cases, notably in the ARREST trial. However, ECPR is resource-intensive and limited to specialized centers, restricting access in many regions. Estimates suggest only 2-10% of out-of-hospital cardiac arrest patients are ECPR candidates. Advanced systems initiating ECPR in prehospital environments or non-ECMO-capable centers have shown promise. As ECPR utilization increases, so does the need for transport to ECMO-capable centers. Unlike conventional out-of-hospital cardiac arrest care, high-quality evidence for post-resuscitation management of ECPR patients is lacking. This review provides suggestions for the immediate post-resuscitation management (4-6 h) of ECPR patients in prehospital settings, the critical care transport medicine environment, and at non-ECMO-capable centers. Goals include treating the precipitating cause of cardiac arrest, maintaining end-organ perfusion, optimizing oxygen delivery, promoting myocardial recovery, and preventing complications associated with V-A ECMO. Continued research is needed to establish evidence-based protocols that ensure the safe and effective management of ECPR patients.
尽管在医疗护理方面取得了进展，但院外心脏骤停的存活率仍然很低。体外心肺复苏（ECPR）在某些特定病例中显示出更好的治疗效果，尤其是在ARREST试验中。然而，ECPR资源消耗大，且仅限于专业中心，这限制了许多地区患者获得该治疗的机会。据估计，只有2%至10%的院外心脏骤停患者适合接受ECPR治疗。在院前环境或没有体外膜肺氧合（ECMO）能力的中心启动ECPR的先进系统已显示出前景。随着ECPR应用的增加，将患者转运至具备ECMO能力的中心的需求也在增加。与传统的院外心脏骤停护理不同，目前缺乏关于ECPR患者复苏后管理的高质量证据。本综述针对院前环境、重症护理转运医学环境以及没有ECMO能力的中心中ECPR患者复苏后立即（4至6小时）的管理提供了建议。目标包括治疗心脏骤停的诱发原因、维持终末器官灌注、优化氧输送、促进心肌恢复以及预防与静脉-动脉体外膜肺氧合相关的并发症。需要持续开展研究以建立基于证据的方案，确保对ECPR患者进行安全有效的管理。
