Out-of-hospital extracorporeal cardiopulmonary resuscitation. There is a rational justification for its use.

Abstract

It has been 52 years since Dr. J. Donald Hill used a membrane oxygenator for the first time in history to support a patient who had suffered a thoracic trauma and almost 50 since Dr. Robert Bartlett did the same on a neonatal patient. All this allowed ECMO to quickly find another field of application in patients with refractory cardiorespiratory arrest, as a mechanism to restore circulation and maintain oxygen delivery to the tissues. There is no clear consensus on when to start switching from conventional CPR to CPR. If we decide to start it prematurely, it is possible that the patient would have returned to spontaneous circulation (ROSC) without the need for ECPR. But if we take too long to start it, we would have too long a low flow time with unfavorable consequences for the patient. With the knowledge that we have at this time, we understand that that out-of-hospital ECPR has not been shown to be superior to conventional CPR maneuvers during the cardiorespiratory arrest witnessed. To achieve these results, the cannulator equipment must be trained and the continuity of CPR maneuvers must be guaranteed until the start of ECPR. ELSO guidelines establish a reasonable time of 20 min before starting ECPR, however, the evidence we have comes from patients in whom it has been started early, at 15 min. The maximum time we have before starting an ECPR according to the ELSO is 60 min and in reality this is very reasonable, due to the poor neurological results obtained with longer times.