Technique or Application

Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-volume Extracorporeal Membrane Oxygenation Center

¹ Tufts University School of Medicine, Boston, MA, 02111, USA
² Department of Cardiac Surgery, Maine Medical Center, Portland, ME, 04102, USA
³ Department of Cardiovascular Perfusion, Maine Medical Center, Portland, ME, 04102, USA
⁴ Department of Advanced Heart Failure and Transplant Cardiology, Maine Medical Center, Portland, ME, 04102, USA
⁵ Department of Cardiovascular Medicine, and Cardiovascular Critical Care Services, Maine Medical Center, Portland, ME, 04102, USA

^* Corresponding author: bram.geller@mainehealth.org

Received: 9 August 2023
Accepted: 20 October 2023

Abstract

Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging approach to cardiac arrest. We present two contrasting cases from a high-volume extracorporeal membrane oxygenation (ECMO) center (defined as greater than 30 ECMO cases per year) without a 24/7 ECPR program to highlight how to establish an ECPR program with a focus on patient selection and outcome optimization. In one case, a patient presented with cardiac arrest during initial triage for chest pain within the emergency department, and in the other case, a patient experienced an out-of-hospital cardiac arrest with prolonged no-flow and low-flow time. Despite the lack of a 24/7 ECPR program at the presenting center, both patients received an ECPR evaluation, as both patients presented while all services necessary for ECMO cannulation were available. The in-hospital cardiac arrest patient was successfully cannulated for ECMO during cardiopulmonary resuscitation and survived with few complications. The out-of-hospital cardiac arrest patient was deemed a poor candidate for ECPR and expired soon after presentation. These two cases highlight the complex decision-making in ECPR and further illustrate how to create ECPR protocols at a high-volume ECMO center before resources are available for a 24/7 ECPR program.