eCPR bei prähospitalem therapierefraktärem Herz-Kreislauf-Stillstand

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is part of the 2015 ERC-ALS (European Resuscitation Council–Advanced Life Support) guidelines. However, with an increasing use of this therapeutic option for patients in refractory cardiac arrest, considerable uncertainties exist among ALS providers who are not experts in extracorporeal membrane oxygenation (ECMO). Beyond systematic reviews, best practice publications and position statements providing a conceptional framework, no detailed practical guidelines related to medical management, logistic issues and the ALS-compliant integration of eCPR into the resuscitation process are available. Methods: The recent literature has been reviewed with a focus on guidelines, recommendations and reviews of current practice. Our own experience with the design and implementation of a prehospital eCPR program, including interviews with prehospital emergency service providers is considered. Furthermore, audiovisual online resources were identified and added, in order to support understanding of the task alignment during eCPR. Results: Seven core topics were identified: Patient selection, time of decision, alerting of the eCPR teams, adjustment of medical management, team work, management on pump and training. Whereas only little change is necessary to medical management prior to eCPR, logistic considerations are major issues especially in the prehospital setting. Significant uncertainty arises from the fact that eCPR as a method is little known to many non-ECMOlogist ALS providers. Discussion: To achieve the highest possible benefit for out-of-hospital cardiac arrest (OHCA) patients using eCPR, tactical considerations for the prehospital setting should be structured and communicated clearly in advance. In medical management, ALS-compliant high-quality CPR is still paramount. Cannulation is provided by the eCPR team. Areas of uncertainty should be addressed by knowledge dissemination and transfer as well as a structured training program including multimedia resources.