Publication Date

Spring 2019


School of Nursing


Nursing (B.S.N.)


ROSC, ECPR, ECMO, Cardiac arrest, Resuscitation, ECMO, VA ECMO


Analytical, Diagnostic and Therapeutic Techniques and Equipment | Critical Care Nursing | Investigative Techniques | Medicine and Health Sciences | Nursing


Extracorporeal cardiopulmonary resuscitation (ECPR) is a method of resuscitation in which venoarterial (VA) extracorporeal membrane oxygenation(ECMO) is initiated during refractory cardiac arrest. ECPR promises to enhance outcomes after cardiac arrest by minimizing neurological deficits, stabilizing the patient for early reperfusion and hypothermia, and serving as a bridge to treatment or transplant. ECPR must be initiated according to structured guidelines and protocols, which are based on the patient’s age, comorbidities, code status, neurological baseline, no flow time, and low flow time.

If a patient achieves return of spontaneous circulation on ECMO, the patient will receive post cardiac arrest care which includes but is not limited to therapeutic hypothermia, early reperfusion, intra-aortic balloon pump insertion, tight glycemic control, and low ventilation. While ECPR has been shown to improve outcomes, multiple complications including bleeding, infection, renal failure, limb ischemia, and stroke can result from the treatment. Nurses play a key role in monitoring these critical patients and achieving therapeutic outcomes.

As ECPR is expensive, carries high risk of complications, and can not always be performed under informed consent, thus there are ethical implications. A review of the literature indicates that low flow time, age, percutaneous intervention, and sustained ventricular fibrillation are independent factors that directly impact patient outcomes. With advances in ECPR and its use in the clinical setting, it is evident that randomized control trials and uniform ECPR protocols and guidelines are essential to improve evidence base practice and patient outcomes.