eCPR: Correcting the failures ACLS leaves behind!

Welcome to ECMOvember 2014!! Apologies for the late start, but I think you will agree the wait was worth it! Today we have a talk that I gave at the San Antonio Military Medical Center (SAMMC) ECMO conference just one week previous. I will argue that the use of Extracorporeal Cardiopulmonary Resuscitation is superior to ACLS protocols in every way. This talk is my own ideas and thoughts and does not at all reflect the military opinion, at least not yet… It is on a topic that is HOT HOT HOT: the use of VA-ECMO for the coding patient. After 30 minutes I think you will agree: you need to master this NOW or be left practicing in the past…

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Overview of Extracorporeal Cardiopulmonary Resuscitation (eCPR):

• Recent articles have shown that as of 2013, ACLS protocols yielded ~ 10% 30 day and 1 year survivals for all rhythms associated with OOH cardiac arrests [link]
• To combat this the AHA released 3 adjustments in 2010 to their ACLS algorithms; but recent data shows:
  • We cannot appropriately reach the 50cm depth needed to generate adequate CPP [link]
  • We get too fatigued to reach the 100+ compressions per minute [link]
  • Despite the detriment to patient health, there is still too much “non-compression” time spent waiting before and after shocks [link]
• The use of automated compression devices was promising, but no RCT exists [link]

• eCPR has been around for over a decade and has shown significant promise as a means to resuscitation:
  • When compared to conventional CPR
    • In hospital cardiac arrests have double the intact neurological survival [link]
      • This survival benefit lasted for 2 years after arrest [link]
      • A recent Meta-analysis again substantiated these results! [link]
    • Out of hospital cardiac arrests have 1/25th the mortality rate, 5x the survival rate (out to 90 days!) AND 5x the amount of neurologically intact survivors!! [link]
      • If you are taken to an eCPR capable hospital while in arrest, you have a 13% chance of neurologically intact survival at 6 months, compared to 3% with ACLS…. [link]

When it comes down to it, the time has come to rethink the way we treat our dying friends and family….