J.Jpn. Surg. Soc.. 121(6): 572-578, 2020

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Feature topic

EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION FOR IN-HOSPITAL AND OUT-OF-HOSPITAL CARDIAC ARREST

Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue strategy that has been used to reduce mortality rates among refractory cardiac arrest (CA) patients, although the criteria for its administration are not yet established. In-hospital CA (IHCA) cases tend to have short low-flow duration (LFD), which is defined as the time from the start of the resuscitation process to restoring blood circulation. Since short LFD is a key factor in achieving good outcomes, including neurological outcomes, rapid response systems should play an important role in ECPR for IHCA. As out-of-hospital CA patients usually have longer LFD than those with IHCA, prehospital interventions should be considered to shorten LFD. To achieve good outcomes after ECPR, multidisciplinary extracorporeal membrane oxygenation teams, who play not only clinical but also educational roles to reduce complication rates, should be established. Furthermore, smooth cooperation among cardiologists, cardiac surgeons, emergency physicians, and intensivists are needed, especially in cases of prolonged refractory heart failure after ECPR, when patients may require ventricular assist device implantation and heart transplantation.

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