What is ECPR?
ECPR actually stands for extracorporeal cardiopulmonary resuscitation. It's a method of CPR that incorporates a portable device called ECMO and this device, helps provide circulation and oxygenated blood in patients that present with a cardiac arrest.
For example, when someone has a cardiac arrest, their heart is not providing blood flow to the rest of the body. So theoretically, ECPR mode allows a return of perfusion to the brain and other vital organs in a more sustainable manner than just with external compressions alone, like in standard CPR.
So are we talking about a surgical procedure here?
This can be done in the operating room, but most commonly it's done at the bedside in the emergency department in conjunction with our trauma surgeons. Not every patient is necessarily going to be deemed a CPR candidate when someone has a cardiac arrest:
- The arrest must be witnessed.
- They must receive bystander CPR.
- They need to be of a certain age, such as between 18 and 65 years old.
- And additionally, their heart rhythm needs to be what we call a shock rhythm, meaning that when an automated external defibrillator is applied, it recognizes that the patient is in an irregular heart rhythm, and that would then deliver electricity to restore the patient's rhythm.
As an example, there was Ken Iisaka, a performer at the Cliburn Amateur Piano Competition, and in fact, had just stepped off the stage when he collapsed. Can you tell me why he was a good candidate for ECPR?
When he collapsed, it was witnessed by others. He received immediate bystander CPR. And there was early recognition that he had lost a pulse and aid was applied. This is a patient that was well prior to his cardiac arrest. We were able to mobilize the resources and address Mr. Iisaka’s cardiac arrest.
So he had immediate attention and a very good chance of recovery.
He was the perfect candidate to employ ECMO in ECPR because this allowed us to stabilize him, and also allowed him to be transferred to the cath labwhere he was found to have a 100% blocked artery. And this artery was opened up with two stents and within 48 hours its heart function normalized. Sometimes with patients, 911 is called, and they are not found to be in a shockable rhythm. And so those candidates would not qualify for CPR. It's for those that have had a shockable rhythm, meaning when the aid is applied, it advises a shot to try to restore the heart rhythm.
There are a lot of resources that go into treating these patients, and so we want to be very selective in who we apply it to because our goal is to improve survival, improve neurologic function, and recovery in these patients. And if we know from the get-go that some of these patients have a poor prognosis, then the application of ECPR and ECMO might not be a viable thing for them.
What are the best ways to minimize cardiac arrest?
- Heart, healthy diet
- Exercising on a daily basis with good aerobic activity
- Attempts at weight loss
- Blood pressure control
- Diabetes control
All the things that your doctor tells you always to do. It's easy to say. It's harder to do, but in the long run, it pays dividends.
RESOURCES:
What is extracorporeal cardiopulmonary resuscitation?
Extracorporeal Cardiopulmonary Resuscitation for Out‐of‐Hospital Cardiac Arrest in Adult Patients
