Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest.

Alexander Supady, Fabio Silvio Taccone, Graeme MacLaren, Susanna Price, Jan Bělohlávek, Demetri Yannopoulos, Daniel Brodie, Alain Combes, Marcel van de Poll, Roberto Lorusso, Alice Hutin, Ingrid Magnet, Dawid L Staudacher

Journal: The Lancet. Respiratory medicine 2025;13(9):843-856

PMID: 40456239

Free Full Text on Elsevier Science View on PubMed

Abstract

When conventional cardiopulmonary resuscitation (CCPR) cannot restore spontaneous circulation, the initiation of venoarterial extracorporeal membrane oxygenation during refractory cardiac arrest-known as extracorporeal CPR (ECPR)-might restore circulation and adequate tissue oxygenation. ECPR could substantially improve survival with favourable functional recovery. However, the complexity and time-sensitive nature of the intervention, high costs, resource demands, considerable risks, and complications restrict the availability of ECPR. Patient age and comorbidities, timely and effective CCPR, and time-to-ECPR are major contributors to the outcome of patients. The primary goal of ECPR is full recovery of the patient, but in some cases, transition to a long-term ventricular assist device or heart transplantation can be additional options for survival. In patients diagnosed with brain death or, according to local regulation, in those with irreversible post-anoxic brain damage, organ donation is possible after ECPR. Ongoing research aims to assess the efficacy of ECPR versus continued CCPR and uncover key prognostic indicators.

Address: Interdisciplinary Medical Intensive Care, University Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: [email protected].; 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; Institute for Heart Diseases, Wrocław Medical University, Wrocław, Poland.; Institute of Cardiometabolism and Nutrition, INSERM UMRS 1166, Sorbonne University, Paris, France; Service de Médecine Intensive-Réanimation, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.; SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; National Veterinary School of Alfort, INSERM Unit 955, Maisons-Alfort, France.; Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastrict, Netherlands; Cardiovascular Research Institute Maastricht, Maastrict University, Maastricht, Netherlands.; Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health Systems, Singapore.; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.; Department of Intensive Care, Maastricht University Medical Center, Maastricht, Netherlands.; Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.; Interdisciplinary Medical Intensive Care, University Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.; Department of Intensive Care, Brussels University Hospital, Free University of Brussels, Brussels, Belgium.; University of Minnesota Center for Resuscitation Medicine and Division of Cardiology, Minneapolis, MN, USA.; Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

DOI: 10.1016/S2213-2600(25)00122-5

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MeSH Terms: Humans, Extracorporeal Membrane Oxygenation, Cardiopulmonary Resuscitation, Heart Arrest