1. Extracorporeal Cardiopulmonary Resuscitation (ECPR) in Adults:
Improving the Odds?
Christopher Bishop
Clinical Perfusionist
Barts Heart Centre

2. Cardiac Arrest Outcomes
Out-of-hospital arrest (OHCA) – 8.6%
survival to discharge
In-hospital arrest (IHCA) – 14.6%

3. Cardiac Arrest – The Chain of Survival

4. CPR Haemodynamics and Survival
Optimal CPR generates
CI 0.6 L/min/m2 (25-33% of normal)
↑Coronary/cerebral perfusion pressure
vital for ROSC during CPR
Interruptions to compressions
↓survival
Could extracorporeal resuscitation
better target haemodynamics and
oxygenation?

6. Advanced Life Support – Guidelines 2015

7. CoSTR 2015 – Extracorporeal CPR (ECPR)
Recommendation: “We suggest ECPR is a reasonable rescue therapy for selected patients with cardiac arrest when initial conventional CPR is failing in settings where this can be implemented”

8. What is ECPR?
Emergency initiation of ECLS during refractory cardiac arrest
Cannulation and high-quality CPR undertaken simultaneously
Variety of settings – ED, ITU, Catheterisation Laboratory, Pre-hospital
Augments end-organ perfusion and haemodynamics during arrest
Buys time to identify/treat underlying cause and achieve ROSC (e.g. PE, MI, drug overdose

9. ECPR Set-Up

10. ECPR “without walls”….

11. ECPR following mechanical chest compressions
From: Menegazzi et al. Resuscitation (2012) 83(1):

12. Haemodynamic and metabolic parameters following ECPR
↑pH
↑MAP
↑Tissue O2 saturations (NIRS)
↑PO2
↓PCO2
↓Plasma K+
From: Mlcek et al. (2012) Physiol. Res. 61 (Suppl. 2): S57-S65, 2012

13. ECPR Outcomes - ELSO

14. Ouweneel et al. 2016

15. Patient Selection for ECPR
Age <60 years
Initial rhythm VF/VT
Chest compressions within 10 mins arrest
Refractory arrest >30 mins
No ROSC despite standard ALS
No major comorbidities
Likely reversible cause (hypothermia/intoxication/ACS)

17. CHEER Results
54 % Survival!

18. 55% Survival!

19. ECPR in the Future?
Pre-hospital ECMO Heart Attack Centre Cardiac Cath Lab ECMO ICU

20. Summary
ECPR has strong physiological and evidence base to support use and ongoing development
Larger studies required:
- To improve case selection
- Allow comparison between services
-Compare conventional CPR and ECPR outcomes

21. Thank You!