Extracorporeal life support in the emergency department: A narrative review for the emergency physician

Justyna Swol* (First author), Jan Belohlávek, Daniel Brodie, Joseph Bellezzo, Scott D Weingart, Zachary Shinar, Andreas Schober, Matthew Bachetta, Jonathan W Haft, Shingo Ichiba, Tetsuya Sakamoto, Giles J Peek, Roberto Lorusso, Steven A Conrad

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

40 Citations (Web of Science)

Abstract

BACKGROUND: Extracorporeal life support (ECLS) describes the use of blood perfusion devices to provide advanced cardiac or respiratory support. Advances in percutaneous vascular cannula insertion, centrifugal pump technologies, and the miniaturization of extracorporeal devices have simplified ECLS. The intention of this discussion is to review the role of ECLS as a potential rescue method for emergency department (ED) clinicians in critical clinical scenarios and to focus on the prerequisites for managing an ECLS program in an ED setting.

DISCUSSION: Possible indications for ECLS cannulation in the ED include ongoing circulatory arrest, shock or refractory hypoxemia and pulmonary embolism with refractory shock. Severe trauma, foreign body obstruction, hypothermia and near drowning are situations in which patients may potentially benefit from ECLS. Early stabilization in the ED can provide a time window for a diagnostic workup and/or urgent procedures, including percutaneous coronary intervention, rewarming or damage control surgery in trauma. The use of ECLS is resource intensive and can be associated with a high risk of complications, especially when performed without previous training. Therefore, ECLS should only be used when the underlying problem is potentially reversible, and the resources are available to address the etiology of organ dysfunction.

CONCLUSION: Emergent ECLS has a role in the ED for selected indications in the face of life-threatening conditions. ECLS provides a bridge to recovery, definitive therapy, intervention or surgery. ECLS program requires an appropriately trained staff (physicians, nurses and ECLS specialists), equipment resources and logistical planning.

Original languageEnglish
Pages (from-to)108-117
Number of pages10
JournalRESUSCITATION
Volume133
DOIs
Publication statusPublished - Dec 2018

Keywords

  • RESPIRATORY-DISTRESS-SYNDROME
  • HOSPITAL CARDIAC-ARREST
  • CARDIOPULMONARY-RESUSCITATION ECPR
  • REFRACTORY CARDIOGENIC-SHOCK
  • BLUNT CHEST TRAUMA
  • MEMBRANE-OXYGENATION
  • PREDICTING SURVIVAL
  • BRONCHIAL DISRUPTION
  • MULTITRAUMA PATIENTS
  • MULTIPLE INJURIES

Fingerprint

Dive into the research topics of 'Extracorporeal life support in the emergency department: A narrative review for the emergency physician'. Together they form a unique fingerprint.

Cite this