ECPR

ECPR
Name	ECPR
Caption	Extracorporeal cardiopulmonary resuscitation setup
Specialty	Cardiac surgery; Critical care; Emergency medicine

ECPR

ECPR is a resuscitative strategy that integrates extracorporeal life support with advanced cardiopulmonary resuscitation to restore circulation in refractory cardiac arrest. It is applied in controlled environments combining expertise from Johns Hopkins Hospital, Massachusetts General Hospital, Mayo Clinic, Cleveland Clinic, Toronto General Hospital, Charité – Universitätsmedizin Berlin, Hôpital Pitié-Salpêtrière, Karolinska University Hospital, Royal Brompton Hospital, St Thomas' Hospital and multidisciplinary teams from American Heart Association, European Resuscitation Council, Resuscitation Council (UK), International Liaison Committee on Resuscitation. The approach intersects cardiothoracic surgery, emergency medicine, perfusion science, and critical care protocols used in centers like Guy's and St Thomas NHS Foundation Trust, UCLA Medical Center, Stanford Health Care, Cedars-Sinai Medical Center, Mount Sinai Hospital (New York), and University College London Hospitals.

Definition and Terminology

ECPR denotes the deployment of venoarterial extracorporeal membrane oxygenation using cannulation and circuit components from manufacturers and clinical teams associated with Maquet, Getinge, LivaNova, Medtronic, Abiomed, Terumo, following guidelines endorsed by American College of Cardiology, European Society of Cardiology, Society of Critical Care Medicine, American Thoracic Society, and protocols referenced in publications from The Lancet, New England Journal of Medicine, JAMA, Circulation, Resuscitation (journal). Related terms include extracorporeal life support used in Berlin Heart pediatric programs, mobile extracorporeal services modeled after systems in Paris, Singapore General Hospital, Royal Melbourne Hospital, and prehospital initiatives like those trialed in Oslo University Hospital and Rigshospitalet.

History and Development

The conceptual roots trace to extracorporeal circulation milestones at John Gibbon, Christian Barnard, and institutes such as Cleveland Clinic Foundation that advanced cardiac bypass. Early extracorporeal resuscitation cases emerged alongside developments at Guy de Chauliac Hospital and research from University of Michigan Hospitals and Washington University in St. Louis. Translational advances were informed by military and disaster medicine programs at Walter Reed National Military Medical Center, USNS Mercy, and studies conducted at Duke University Hospital, Vanderbilt University Medical Center, University of Pennsylvania Health System, Bellevue Hospital, University of Tokyo Hospital, and Seoul National University Hospital. Large multicenter registries and randomized efforts grew from collaborations involving Extracorporeal Life Support Organization, National Institutes of Health, Canadian Institutes of Health Research, National Health Service (England), Australian National Health and Medical Research Council, and investigator groups at Brigham and Women's Hospital and Karolinska Institutet.

Indications and Patient Selection

Indications prioritize reversible causes of arrest identified through diagnostics available at institutions like Cleveland Clinic and Mayo Clinic and triage informed by algorithms developed by American Heart Association and European Resuscitation Council. Typical selection criteria reference age brackets seen in cohorts from Johns Hopkins Hospital, witnessed arrest data from Mount Sinai Hospital (New York), initial rhythm considerations studied at Stanford Health Care and UCLA Medical Center, low-flow duration thresholds derived from trials at Toronto General Hospital and Charité – Universitätsmedizin Berlin, and comorbidity profiling used in registries at Mayo Clinic and Massachusetts General Hospital. Contraindications align with terminal disease protocols from Memorial Sloan Kettering Cancer Center, irreversible neurologic injury frameworks from Barnes-Jewish Hospital, and futility criteria applied by ethics committees at Harvard Medical School and University of Oxford.

Procedure and Technical Considerations

Procedural workflows combine cannulation techniques standardized in surgical texts used at Cleveland Clinic and Mayo Clinic, imaging adjuncts from GE Healthcare and Philips Healthcare, and perfusion practices codified in training at Association of Anaesthetists of Great Britain and Ireland and American Society of Anesthesiologists. Venoarterial cannulation via femoral or central approaches reflects methods practiced at Royal Prince Alfred Hospital, GH Sorlandet, and Sheffield Teaching Hospitals, with portable systems and mobile teams modeled after Paris SAMU and Oslo University Hospital. Anticoagulation, flow management, oxygenator selection, and circuit priming reference manufacturer guidance from Maquet and Medtronic and institutional protocols at University of California, San Francisco Medical Center and NewYork-Presbyterian Hospital. Coordination among cardiothoracic surgeons, intensivists, emergency physicians, and perfusionists follows models from St Bartholomew's Hospital and Royal Infirmary of Edinburgh.

Outcomes and Prognosis

Outcomes data derive from multicenter registries maintained by Extracorporeal Life Support Organization and cohort studies published by teams at Toronto General Hospital, Massachusetts General Hospital, Mayo Clinic, Stanford Health Care, Charité – Universitätsmedizin Berlin, and Karolinska University Hospital. Survival to hospital discharge and neurologically favorable outcomes are reported variably across systems like US Veterans Health Administration, NHS Scotland, and Australian Intensive Care Society networks. Predictors of favorable prognosis identified in studies from Brigham and Women's Hospital, Vanderbilt University Medical Center, University College London Hospitals, and University of Toronto include short no-flow intervals, initial shockable rhythms, and reversible etiologies noted in series from Cedars-Sinai Medical Center and Mount Sinai Hospital (New York).

Complications and Risks

Complication profiles compile hemorrhagic, thrombotic, limb ischemia, and infection risks documented by researchers at Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, Charité – Universitätsmedizin Berlin, and registries curated by Extracorporeal Life Support Organization. Vascular injury and neurologic injury reports mirror findings from UCLA Medical Center, Stanford Health Care, Toronto General Hospital, Royal Infirmary of Edinburgh, and Hôpital Lariboisière. Device-related failures, oxygenator dysfunction, and sepsis cases align with safety advisories issued by Food and Drug Administration and surveillance summaries from European Medicines Agency.

Ethical, Legal, and Resource Considerations

Ethical deliberations, legal frameworks, and resource allocation models arise in guidance from American Medical Association, British Medical Association, World Health Organization, National Institutes of Health, Nuffield Council on Bioethics, Canadian Medical Association, and national health services such as NHS England and Medicare (Australia). Cost-effectiveness, regionalization, and center-volume debates reference health-economic analyses produced by teams at Harvard School of Public Health, London School of Economics, University of Toronto Department of Health Policy, Johns Hopkins Bloomberg School of Public Health, and policy studies from Organisation for Economic Co-operation and Development. Legal precedent, consent processes, and end-of-life decision frameworks draw on case law in jurisdictions represented by institutions such as Supreme Court of the United States, European Court of Human Rights, High Court of Justice (England and Wales), and regulatory opinions from Centers for Medicare & Medicaid Services.

Category:Extracorporeal membrane oxygenation