ECMO in Resuscitation

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Survival rates after cardiopulmonary resuscitation (CPR) for cardiopulmonary arrest have improved over the past decade; however, there is still need for further enhancement.1–8 The advanced cardiac life support and pediatric advanced life support guidelines of the American Heart Association (AHA) emphasize the importance of high-quality CPR and minimal interruptions.2,9 The probability of achieving return of spontaneous circulation decreases after 10 minutes of conventional CPR.5,7,10 In certain situations, extracorporeal membrane oxygenation (ECMO) may be used to reestablish and sustain circulation when conventional CPR fails. In addition, high-quality CPR provides <25% of blood flow to the vital organs, requiring a timely decision for initiation of extracorporeal CPR (ECPR).11 The AHA lists ECPR in their most recent guidelines as a class IIb recommendation for patients with a suspected reversible etiology for cardiac arrest.9 The intent of this review is to discuss the indications for ECPR in pediatric and adult patients and the logistic issues that arise during ECPR.
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