Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being deployed for selected patients in cardiac arrest who do not attain a native circulation with conventional CPR (ECPR). This ELSO guideline is intended to be a practical guide to implementing ECPR and the early management following establishment of ECMO support. Where a paucity of high-quality evidence exists, a consensus has been reached amongst the authors to provide guidance to the clinician. This guideline will be updated as further evidence in this field becomes available.

Ambulance Victoria Victoria Australia

Columbia University Medical Center New York New York

From the The Alfred Hospital Melbourne Australia

General University Hospital Prague Czech Republic

Northwell Health New York New York

St Bartholomew's Hospital NHS London United Kingdom

University of Minnesota Medical Center Minneapolis Minnesota

University of Utah Hospital Salt Lake City Utah

University Paris Descartes Paris France

UTSouthwestern Medical Center Dallas Texas

Vancouver Coastal Health Vancouver British Columbia

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Jacobs I, Nadkarni V, Outcomes tITFoCAaCR, et al.: Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update and Simplification of the Utstein Templates for Resuscitation Registries: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 110 (21): 3385–3397, 2004. doi: 10.1161/01.CIR.0000147236.85306.15. PubMed DOI

Soar J, Maconochie I, Wyckoff MH, et al.: 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 140 (24): e826–e880, 2019. doi: 10.1161/CIR.0000000000000734. PubMed DOI

Bougouin W, Dumas F, Lamhaut L, et al.: Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J, 2019. doi: 10.1093/eurheartj/ehz753. PubMed DOI

Debaty G, Babaz V, Durand M, et al.: Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation 112: 1–10, 2017. doi: 10.1016/j.resuscitation.2016.12.011. PubMed DOI

Chen Y-S, Lin J-W, Yu H-Y, et al.: Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. The Lancet 372 (9638): 554–561, 2008. doi: 10.1016/S0140-6736(08)60958-7. PubMed DOI

Lamhaut L, Hutin A, Puymirat E, et al.: A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis. Resuscitation 117: 109–117, 2017. doi: 10.1016/j.resuscitation.2017.04.014. PubMed DOI

Sakamoto T, Morimura N, Nagao K, et al.: Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study. Resuscitation 85 (6): 762–768, 2014. doi: 10.1016/j.resuscitation.2014.01.031. PubMed DOI

Stub D, Bernard S, Pellegrino V, et al.: Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation 86: 88–94, 2015. doi: 10.1016/j.resuscitation.2014.09.010. PubMed DOI

Yannopoulos D, Bartos JA, Raveendran G, et al.: Coronary Artery Disease in Patients With Out-of-Hospital Refractory Ventricular Fibrillation Cardiac Arrest. J Am Coll Cardiol 70 (9): 1109–1117, 2017. doi: 10.1016/j.jacc.2017.06.059. PubMed DOI

Richardson AS, Schmidt M, Bailey M, Pellegrino VA, Rycus PT, Pilcher DV: ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation 112: 34–40, 2017. doi: 10.1016/j.resuscitation.2016.12.009. PubMed DOI

Donnino M, Andersen L, Deakin C, et al.: Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Cardiac Arrest – Adults Consensus on Science with Treatment Recommendations [DRAFT], International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force, 2018.

Neumar RW, Shuster M, Callaway CW, et al.: Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 132 (18 suppl 2): S315–S367, 2015. doi: 10.1161/CIR.0000000000000252. PubMed DOI

Yannopoulos D, Bartos JA, Aufderheide TP, et al.: The Evolving Role of the Cardiac Catheterization Laboratory in the Management of Patients With Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 139 (12), 2019 doi: 10.1161/CIR.0000000000000630. PubMed DOI

D’Arrigo S, Cacciola S, Dennis M, et al.: Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis. Resuscitation 121: 62–70, 2017. doi: 10.1016/j.resuscitation.2017.10.005. PubMed DOI

Wengenmayer T, Rombach S, Ramshorn F, et al.: Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care 21 (1): 157, 2017. doi: 10.1186/s13054-017-1744-8. PubMed DOI PMC

Reynolds JC, Frisch A, Rittenberger JC, Callaway CW: Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation [Multicenter Study] 128 (23): 2488–94, 2013. doi: 10.1161/CIRCULATIONAHA.113.002408. PubMed DOI PMC

Goto Y, Funada A, Goto Y: Relationship Between the Duration of Cardiopulmonary Resuscitation and Favorable Neurological Outcomes After Out-of-Hospital Cardiac Arrest: A Prospective, Nationwide, Population-Based Cohort Study. Journal of the American Heart Association 5 (3): e002819, 2016. doi: 10.1161/JAHA.115.002819. PubMed DOI PMC

Bartos JA, Grunau B, Carlson C, al. e: Improved survival with extracorporeal life support despite progressive metabolic derangement associated with prolonged resuscitation. Journal of the American College of Cardiology, 2019.

Tonna JE, Selzman CH, Mallin MP, et al.: Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program. Ann Emerg Med 70 (1): 32–40, 2017. doi: 10.1016/j.annemergmed.2016.10.001. PubMed DOI

Koster RW, Beenen LF, van der Boom EB, et al.: Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. European Heart Journal 38 (40): 3006–3013, 2017. doi: 10.1093/eurheartj/ehx318. PubMed DOI PMC

Mooney MR, Arom KV, Joyce LD, et al.: Emergency cardiopulmonary bypass support in patients with cardiac arrest. The Journal of Thoracic and Cardiovascular Surgery 101 (3): 450–454, 1991. PubMed

Conrad SA, Grier LR, Scott LK, Green R, Jordan M: Percutaneous Cannulation for Extracorporeal Membrane Oxygenation by Intensivists: A Retrospective Single-Institution Case Series*. Critical Care Medicine 43 (5): 1010–1015, 2015. doi: 10.1097/CCM.0000000000000883. PubMed DOI

Bellezzo JM, Shinar Z, Davis DP, et al.: Emergency physician-initiated extracorporeal cardiopulmonary resuscitation. Resuscitation 83 (8): 966–970, 2012. doi: 10.1016/j.resuscitation.2012.01.027. PubMed DOI

Fair J, Tonna J, Ockerse P, et al.: Emergency physician-performed transesophageal echocardiography for extracorporeal life support vascular cannula placement. Am J Emerg Med 34 (8): 1637–9, 2016. doi: 10.1016/j.ajem.2016.06.038. PubMed DOI

Guidelines for the Use of Transesophageal Echocardiography (TEE) in the ED for Cardiac Arrest. Ann Emerg Med 70 (3): 442–445, 2017. doi: 10.1016/j.annemergmed.2017.06.033. PubMed DOI

Juo Y-Y, Skancke M, Sanaiha Y, Mantha A, Jimenez JC, Benharash P: Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis: EFFICACY OF DPC IN PREVENTING LIMB ISCHEMIA DURING ECMO. Artificial organs 41 (11): E263–E273, 2017. doi: 10.1111/aor.12942. PubMed DOI

Kaufeld T, Beckmann E, Ius F, et al.: Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach? Perfusion: 267659119827231, 2019 doi: 10.1177/0267659119827231. PubMed DOI PMC

Kim J, Cho YH, Sung K, et al.: Impact of Cannula Size on Clinical Outcomes in Peripheral Venoarterial Extracorporeal Membrane Oxygenation:. ASAIO Journal: 1, 2018 doi: 10.1097/MAT.0000000000000858. PubMed DOI

Burkhoff D, Sayer G, Doshi D, Uriel N: Hemodynamics of Mechanical Circulatory Support. J Am Coll Cardiol 66 (23): 2663–2674, 2015. doi: 10.1016/j.jacc.2015.10.017. PubMed DOI

Ibrahim AW, Trammell AR, Austin H, et al.: Cerebral Oximetry as a Real-Time Monitoring Tool to Assess Quality of In-Hospital Cardiopulmonary Resuscitation and Post Cardiac Arrest Care. J Am Heart Assoc 4 (8): e001859, 2015. doi: 10.1161/JAHA.115.001859. PubMed DOI PMC

Murphy RA, Bobrow BJ, Spaite DW, Hu C, McDannold R, Vadeboncoeur TF: Association between Prehospital CPR Quality and End-Tidal Carbon Dioxide Levels in Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care 20 (3): 369–77, 2016. doi: 10.3109/10903127.2015.1115929. PubMed DOI

Sheak KR, Wiebe DJ, Leary M, et al.: Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest. Resuscitation 89: 149–54, 2015. doi: 10.1016/j.resuscitation.2015.01.026. PubMed DOI

Bartos JA, Carlson K, Carlson C, et al.: Surviving refractory out-of-hospital ventricular fibrillation cardiac arrest: Critical care and extracorporeal membrane oxygenation management. Resuscitation 132: 47–55, 2018. doi: 10.1016/j.resuscitation.2018.08.030. PubMed DOI

Abrams D, Combes A, Brodie D: Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol 63 (25 Pt A): 2769–78, 2014. doi: 10.1016/j.jacc.2014.03.046. PubMed DOI

Patel SM, Lipinski J, Al-Kindi SG, et al.: Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Percutaneous Left Ventricular Decompression Therapy with Impella Is Associated with Improved Outcomes in Refractory Cardiogenic Shock. ASAIO J, 2018. doi: 10.1097/MAT.0000000000000767. PubMed DOI

Munshi L, Kiss A, Cypel M, Keshavjee S, Ferguson ND, Fan E: Oxygen Thresholds and Mortality During Extracorporeal Life Support in Adult Patients*:. Critical Care Medicine 45 (12): 1997–2005, 2017. doi: 10.1097/CCM.0000000000002643. PubMed DOI

Schneider AG, Eastwood GM, Bellomo R, et al.: Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest. Resuscitation 84 (7): 927–934, 2013. doi: 10.1016/j.resuscitation.2013.02.014. PubMed DOI

Chen YS, Chao A, Yu HY, et al.: Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol 41 (2): 197–203, 2003. PubMed

Grunau B, Scheuermeyer FX, Stub D, et al.: Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest. CJEM : Canadian journal of emergency medical care = JCMU : journal canadien de soins médicaux d'urgence: 1–8, 2016. doi: 10.1017/cem.2016.8. PubMed DOI

Goto T, Morita S, Kitamura T, et al.: Impact of extracorporeal cardiopulmonary resuscitation on outcomes of elderly patients who had out-of-hospital cardiac arrests: a single-centre retrospective analysis. BMJ Open 8 (5): e019811, 2018. doi: 10.1136/bmjopen-2017-019811. PubMed DOI PMC

International Consensus on Evidence Gaps and Research Opportunities in Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: A Report From the National Heart, Lung, and Blood Institute Workshop

Age as a Mortality Predictor in ECPR Patients

Current animal models of extracorporeal cardiopulmonary resuscitation: A scoping review

Ten years of our translational research in the field of veno-arterial extracorporeal membrane oxygenation