TY - JOUR
T1 - Extracorporeal life support in the emergency department
T2 - A narrative review for the emergency physician
AU - Swol, Justyna
AU - Belohlávek, Jan
AU - Brodie, Daniel
AU - Bellezzo, Joseph
AU - Weingart, Scott D
AU - Shinar, Zachary
AU - Schober, Andreas
AU - Bachetta, Matthew
AU - Haft, Jonathan W
AU - Ichiba, Shingo
AU - Sakamoto, Tetsuya
AU - Peek, Giles J
AU - Lorusso, Roberto
AU - Conrad, Steven A
N1 - Swol, J: Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany
PY - 2018/12
Y1 - 2018/12
N2 - 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.
AB - 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.
KW - RESPIRATORY-DISTRESS-SYNDROME
KW - HOSPITAL CARDIAC-ARREST
KW - CARDIOPULMONARY-RESUSCITATION ECPR
KW - REFRACTORY CARDIOGENIC-SHOCK
KW - BLUNT CHEST TRAUMA
KW - MEMBRANE-OXYGENATION
KW - PREDICTING SURVIVAL
KW - BRONCHIAL DISRUPTION
KW - MULTITRAUMA PATIENTS
KW - MULTIPLE INJURIES
U2 - 10.1016/j.resuscitation.2018.10.014
DO - 10.1016/j.resuscitation.2018.10.014
M3 - Review article
C2 - 30336233
SN - 0300-9572
VL - 133
SP - 108
EP - 117
JO - RESUSCITATION
JF - RESUSCITATION
ER -