Extra-corporeal cardiopulmonary resuscitation in the emergency department for refractory cardiac arrest: a systematic review
DOI:
https://doi.org/10.65759/3p0r1489Keywords:
Extracorporeal cardiopulmonary resuscitation, Extracorporeal membrane oxygenation, extracorporeal membrane oxygenation, Emergency department, refractory cardiac arrestAbstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue strategy for RCA, and its value in emergency department (ED) settings still uncertain as outcomes depend on patient selection, timing, and system organization. Methods: This systematic review followed PRISMA principles and included original studies evaluating ECPR or ED extracorporeal membrane oxygenation for refractory cardiac arrest (RCA). PubMed/MEDLINE, Scopus, and Web of Science were searched. Eligible studies reported survival, neurological outcomes, workflow measures, or ECPR-related process outcomes. Data were analyzed narratively because of clinical and methodological heterogeneity. Results: We include seven original studies published between 2012 and 2025. Studies were conducted in the United States, South Korea, Austria, China, and Japan, with sample sizes ranging from 29 to 192 patients. Emergency ECPR was feasible when delivered through structured protocols and trained teams. Survival to discharge or longer-term survival varied in studies, and neurological recovery was reported in selected patients with witnessed arrest, shockable rhythm, shorter low-flow or ACLS duration, and rapid access to extracorporeal support. Dedicated ECLS teams and hybrid ED systems shortened ECPR initiation times. Conclusion: Emergency ECPR benefit highly selected RCA patients when delivered within organized and experienced systems.
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