A Novel Extracorporeal Cardiopulmonary Resuscitation Strategy Using a Hybrid Emergency Room for Patients With PEA

Abstract Background: Whether extracorporeal cardiopulmonary resuscitation (ECPR) is indicated for pulseless electrical activity (PEA) remains unclear. Pulmonary embolism with PEA was a good candidate for ECPR; however, PEA sometimes include an aortic disease and intracranial haemorrhage, with extremely poor neurological outcomes, and could not be a candidate. We have induced an ECPR strategy using the hybrid emergency room (ER) to perform computed tomography (CT) before extracorporeal membrane oxygenation (ECMO) induction from January 2020. Therefore, this study aimed to evaluate the effectiveness of our ECPR strategy.Methods: Medical records of patients who transferred to our hybrid emergency room (ER) and required ECPR for PEA between January 2020 and November 2021 were reviewed.Results: Twelve consecutive patients (median age, 67 [range, 57-73] years) with PEA requiring ECPR were identified in our hybrid ER. Among them, nine were diagnosed through initial CT scan (intracranial haemorrhage, 3; cardiac tamponade due to aortic dissection, 3; aortic rupture, 2; and cardiac rupture, 1), and unnecessary ECMO was avoided. The remaining three patients underwent ECPR, and two of them survived with favourable neurological outcomes. All patients not indicated for ECPR were excluded before ECMO induction.Conclusion: Our ECPR strategy using the hybrid ER may be useful for the exclusion of patients with PEA non-indication for ECPR and decision making.