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StayCurrentMD
ECPR patient selection: identifying candidates for extracorporeal cardiopulmonary resuscitation
With Dr. Juan Guerrilla & Dr. David Rothstein · hosted by Lizzy Lee, PA-C
Chapter 1 of 3
ECPR definition
Introduction to ECPR and defining success
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
ECPR is extracorporeal cardiopulmonary resuscitation, which involves adding ECMO or extracorporeal life support membrane oxygenation to conventional CPR to increase outcomes.
Success in ECPR can be defined as survival with a favorable neurologic outcome.
ECPR candidates need to have reversible pathology because ECMO is not a destination but a bridge to try to gain more time.
Not all out of hospital arrests are the same; some patients may have a dismal presentation but reasonable numbers reflecting some sort of circulation, while others may have great community response but terrible numbers.
Great laboratory numbers may be more important than CPR downtime in determining ECPR candidacy.
ECPR doesn't replace conventional CPR; it adds temporary heart and lung support while clinicians work to treat a potentially reversible cause of arrest.
Considerations when deciding if a patient should receive ECPR include the likelihood that they will recover, whether the underlying disease can actually be treated, equitable use of resources, and long-term follow-up.
A child who has had CPR for 30 minutes is not automatically a poor ECPR candidate.
ECPR is reserved for patients who still have a realistic chance of recovery if ECMO can buy enough time, not simply for the sickest patient.
ECPR candidates have had a witnessed arrest, evidence that organs are still being perfused, and a chance that the underlying disease can be fixed.
Laboratory data such as pH, potassium, and evidence of circulation provide valuable context and influence decision making just as much as the duration of CPR.
Choosing the right ECPR patient isn't about following one laboratory value or one time limit; reversible disease matters the most.
It's important to combine physiology, clinical judgment, and preparation to identify the patients most likely to benefit from ECPR.