Extrakorporale Reanimation (ECPR)

Cardiopulmonary resuscitation is as an essential first aid skill, saving countless lives worldwide from cardiac arrest every year. The basic principles of cardiopulmonary resuscitation consist of chest compressions, ventilations, and defibrillation, and did not change much over the last decades. Chances for surviving a cardiac arrest are dependent on many factors. Some of the most important factors are recognizing the cardiac arrest and calling for help, immediately starting cardiopulmonary resuscitation with high quality chest compressions, and administering early defibrillations to rapidly achieve return of spontaneous circulation.
 
However, in some patients, cardiopulmonary resuscitation with chest compressions, ventilation, and defibrillation fails to restore cardiac function and spontaneous circulation.

In some of these patients, extracorporeal resuscitation (ECPR) is an option – a resuscitation strategy that has been increasingly researched and established in recent years. ECPR uses a machine for extracorporeal membrane oxygenation (ECMO) to temporarily replace cardiopulmonary function with extracorporeal circulation. ECMO technology has been successfully used for many years in heart surgery, or life-threatening pulmonary and cardiac failure. The functional principle of ECMO is to drain the patient’s blood via large-bore cannulas into the ECMO machine, where the blood is oxygenated and then pumped back into the body. ECPR uses this “pumping” and “oxygenation” functions of ECMO to restore circulation and sustain oxygenation to vital organs. This temporary extracorporeal circulation allows for the stabilization of the patient, providing time to treat the underlying cause of the cardiac arrest, such as a severe myocardial infarction. However, ECPR poses major challenges for the entire team and can only be used in selected cases. A chain of favourable circumstances are required to sucessfully treat a patient with ECPR, including recognition of the cardiac arrest, immediate start of cardiopulmonary resuscitation by first responders, and time-optimized patient management by the EMS and in-hospital crews.

The Department of Emergency Medicine has been treating patients with ECPR since 1992. Today, the “Vienna ECPR Center“ treats between 60 and 70 patients with refractory cardiac arrest annually using ECPR.

Researching and optimizing the application of ECPR are central tasks of the “Vienna ECPR Research” group, particularly through collaborations with European and international ECPR centers.