Clinical practice of emergency department-initiated extracorporeal cardiopulmonary resuscitation for cardiac arrest in adults

According to the latest American Heart Association reports,[1] the incidences of Emergency Medical Service-assessed adult out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) were 140.7/100,000 and 10.2/1000, respectively. In order to ensure patient safety and provide ample time for further treatment of reversible etiologies, these physicians are primarily responsible for verifying the indications and contraindications for ECPR, performing high-quality CCPR, communicating with families to obtain informed consent, performing ECMO catheterization, managing ECMO operations in the ED, and the final handover to the cardiac catheterization room or intensive care unit; (2) At least two emergency nurses, who mainly assist emergency physicians and are responsible for the preparation of ED ECPR-related instruments and items, routine patient care, monitoring, and bedside coagulation function monitoring, can assume the basic responsibility of a perfusionist after undergoing extensive training on operating the ECMO device, and are responsible for the completion of pre-primed circuits before the end of ECMO catheterization. According to our experience, most patients treated with ED ECPR were transferred and treated for reversible etiologies once vital signs stabilized. When a patient is in a “bridge to nowhere” situation, ECMO is not beneficial therapeutically to the patient and only delays their inevitable demise. [...]ECPR should be discontinued in this unfortunate situation to protect the patient since the likelihood of benefit is very low, and the risk of harm is almost certain.