ECMO Coordinator San Antonio, Texas, United States
Disclosure(s):
Crystal Pearson, RN, MSN: No financial relationships to disclose
Background: Despite advances in extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest, neurologic injury remains the leading cause of death. Improved outcomes have been associated with targeted temperature management (TTM), normocapnia, and avoidance of hyperoxia. Neuromonitoring with near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) have been described without specific targets defined.
Methods: ECPR patients at Methodist Hospital from 2022 to 2024 were reviewed. The neurologic care for patients cannulated for ECPR was standardized across our program. This included TTM at 34°C or 36°C with strict fever avoidance, strict sodium (140-150), pCO₂ (35–45 mmHg), and pO₂ (75–100 mmHg) targets, continuous NIRS monitoring for cerebral oxygenation, and daily TCD monitoring. Survival and cerebral performance category scores (CPC) were retrospectively reviewed at hospital discharge.
Outcome: In 2023-2024, 33 patients underwent ECPR with a total survival rate of 42%. Among survivors, 11 patients were discharged with a CPC score of 1, 1 patient with a CPC score of 2, and 2 patients with a CPC score of 3. These outcomes are notably better than the published survival (31%) reported in the ELSO registry.
Conclusion: The implementation of a standardized approach to neurological management in ECPR patients may contribute to the optimization of clinical outcomes. Further prospective evaluation and external validation of these standardized protocols are warranted.
