Extracorporeal Membrane Oxygenation in the Emergency Department

KEY POINTS

• Venovenous extracorporeal membrane oxygenation (ECMO) provides pulmonary bypass for severe respiratory failure, and venoarterial ECMO provides cardiac and pulmonary bypass for severe cardiac failure including cardiac arrest.
• Inclusion criteria for extracorporeal cardiopulmonary resuscitation (ECPR): reversible cause of arrest, witnessed arrest with bystander CPR, total chest compression time of less than 60 minutes, no known preexisting chronic terminal illnesses.
• The initiation of ECMO is divided into 3 stages: (1) vascular access, (2) insertion of ECMO cannulas and connection to the circuit once the patient is determined to be an ECMO candidate, (3) pump initiation.
• Post-circuit initiation critical care for ECPR includes establishing an arterial line and managing vasopressors, defibrillation if needed, checking an arterial blood gas on right upper extremity, therapeutic hypothermia, adding an inotrope for left ventricular distention, placing a distal perfusion catheter, and treating the underlying cause of arrest.