Affiliation:
1. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
2. Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.
3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
4. Division of Neurosciences Critical Care, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
Abstract
Objectives:
Extracorporeal cardiopulmonary resuscitation (ECPR) serves as a lifesaving intervention for patients experiencing refractory cardiac arrest. With its expanding usage, there is a burgeoning focus on improving patient outcomes through optimal management in the acute phase after cannulation. This review explores systematic post-cardiac arrest management strategies, associated complications, and prognostication in ECPR patients.
Data Sources:
A PubMed search from inception to 2023 using search terms such as post-cardiac arrest care, ICU management, prognostication, and outcomes in adult ECPR patients was conducted.
Study Selection:
Selection includes original research, review articles, and guidelines.
Data Extraction:
Information from relevant publications was reviewed, consolidated, and formulated into a narrative review.
Data Synthesis:
We found limited data and no established clinical guidelines for post-cardiac arrest care after ECPR. In contrast to non-ECPR patients where systematic post-cardiac arrest care is shown to improve the outcomes, there is no high-quality data on this topic after ECPR. This review outlines a systematic approach, albeit limited, for ECPR care, focusing on airway/breathing and circulation as well as critical aspects of ICU care, including analgesia/sedation, mechanical ventilation, early oxygen/Co
2, and temperature goals, nutrition, fluid, imaging, and neuromonitoring strategy. We summarize common on-extracorporeal membrane oxygenation complications and the complex nature of prognostication and withdrawal of life-sustaining therapy in ECPR. Given conflicting outcomes in ECPR randomized controlled trials focused on pre-cannulation care, a better understanding of hemodynamic, neurologic, and metabolic abnormalities and early management goals may be necessary to improve their outcomes.
Conclusions:
Effective post-cardiac arrest care during the acute phase of ECPR is paramount in optimizing patient outcomes. However, a dearth of evidence to guide specific management strategies remains, indicating the necessity for future research in this field.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Critical Care and Intensive Care Medicine
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