February 2015: ECMO in the POST-Cardiac Arrest Patient

This month JC is looking forward to having our Peds EM and ICU colleagues join us to discuss possible applications of ECMO in the EM population. Though ECMO has been utilized for years in neonatal ICU’s and cardiac surgery, it is not a common modality in the post-arrest EM population. Interestingly, a review of the literature will demonstrate that in cold weather countries there have been many case reports of lives saved utilizing ECMO both in the university and community settings. It also seems that those who report successful ECMO outcomes, generally have dedicated teams of experts who can apply the technology expeditiously.  I have included a widely cited CHEER trial for you to review as well as a recent Cochrane review of ECMO in the adult population.  In addition, you will find an article on the utility of ECMO in the pediatric population as well as an incredible case report of a group of students whose ‘dragon boat’ capsized in 2 0C saltwater. Also included is an observational study on 134 subjects from Japan that applied ECMO to a broader group of patients. So, is ECMO ready for prime time in our ED setting and can we define criteria for appropriate patient selection of those most likely to benefit? 

 Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident. Resuscitation. 2012 Sep;83(9):1078-84.  

Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2014 Oct 2.

Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support. A single-center observational study. Circ J. 2012;76(6):1385-92. Epub 2012 Mar 13.

 Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2004 Sep;5(5):440-6.

 Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev. 2015 Jan 22