부산대학교 도서관

Extracorporeal cardiopulmonary resuscitation (ECPR) is a form of intensive life support which has seen globally increasing use to improve outcomes for patients who experience out-of-hospital cardiac arrest (OHCA). Hospitals with advanced critical care capabilities may be interested in launching an ECPR program to offer this support to the patients they serve, but to do so they must first consider the significant investment of resources necessary to start and sustain the program. Existing literature describes many single-center ECPR programs and often focuses on inpatient care and patient outcomes in hospitals with cardiac surgery capability. However, building a successful ECPR program and using this technology to support an individual patient experiencing refractory cardiac arrest secondary to a shockable rhythm depends on efficient prehospital and emergency department (ED) management. This article describes the process of implementing two intensivist-led ECPR programs with limited cardiac surgery capability. We focus on emergency medical services and ED clinician roles in identifying patients, mobilizing resources, initiation and management of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the ED, and ongoing efforts to improve ECPR program quality. Each center experienced a significant learning curve to reach goals of arrest-to-flow times of cannulation for ECPR. Building consensus from multidisciplinary stakeholders including prehospital stakeholders, establishing shared expectations of ECPR outcomes, and ensuring adequate resource support for ECPR activation were all key lessons in improving our ECPR programs.