ECMO in ED for Out of Hospital Cardiac Arrest

Statement reviewed and approved by AAEM Board of Directors. (4/23/2022)

Executive Summary
Emergency departments (ED) and emergency medical services (EMS) are motivated to increase survival following sudden out of hospital cardiac arrest (OHCA).1 Extracorporeal cardiopulmonary resuscitation (ECPR) has been promoted as an option but substantial uncertainty exists regarding how to select patients.2 Recently, a single-center randomized controlled trial demonstrated increased survival with early extracorporeal membrane oxygenation (ECMO), compared to standard care.3 Limited evidence demonstrates some emergency departments have successfully implemented ECPR.4 The observational data is mixed. An overarching problem with existing data is the concept of competing risk. If OHCA patients are being moved to ECPR centers and this were to compromise the delivery of standard advanced cardiac life support measures to other patients, it is possible that ECPR strategies may decrease the survival of a population of OHCA patients. At this point in time, the existing evidence is not strong enough to recommend the use of ECPR for OHCA as a standard of care. Further research is needed, particularly on how the broader OHCA population would be affected.

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Reference and Literature Grading (PDF)