CPR Blog

The CPR Blog is dedicated to providing content focused on all aspects of CPR.

eCPR – A Replacement for CPR? Part I

Extracorporeal Cardiopulmonary Resuscitation or eCPR is argued by some to be superior to ACLS protocols. Let's dive into this topic just a bit more.

Two Facts

It's important to note two facts. First this CPR Blog post is focused on CPR in hospitals and the outcomes shown here are actually a lot worse in the community setting. Second eCPR is not about compressing on the chest or giving breaths. In fact there's no chest compressions once eCPR is started and breathing is optional. More on that in another CPR Blog entry. But first what is eCPR?

What is eCPR?

All true scholarly articles start with a look at what Wikipedia (Right? Many 5th graders think). Read more on Wikipedia. Basically eCPR is a method of CPR that passes the patient's blood through a machine to oxygenate the blood. While not entirely the same, anyone who has undergone "on pump" open heart surgery has likely been on a "by pass pump" which is similar to eCPR. The below figure shows what eCPR looks like. 

Logic Lane –Teaching to Gaps is an AHA Standard

Let's take a quick trip down CPR logic lane. Per the American Heart Association Guidelines we could conclude:

Deep/Continuous Compressions = Good Heart Perfusion = Blood Flow to the Brain = Better Outcomes

Right? Ah No! As anyone who has taken a statics class knows, correlation is not causation. The American Heart Association's educational approach, while great for the mass public education, only looks at the gaps leading to better outcomes (causes for poor outcomes). What if we cannot really get to the outcomes we want because humans cannot physically overcome the poor CPR gaps? I want to go to the moon but there is a lot standing in my way! What this writer is suggesting is the AHA designs educational content that only teaches to the gaps (poor depth, poor rate, and poor hands off time) but in reality humans can never actually bridge the gaps found in chest compression based CPR research. In a moment I'll address why we cannot sustain the machine like requirements of good CPR…the heart truly is a miracle.

Pit Crew Training - That's The Wrong Answer?

You can read moreread more on Pit Crew CPR Training. This writer's full time job is as a nurse in and one an urban, tertiary care center's dedicated code team. I use to really like the Pit Crew model and I use to tech it, but research tells us our dedicated team is not able to address the CPR gaps. I would argue the Pit Crew model addresses a different pressing issue, teamwork. Still even a highly experienced, dedicated code team (teams that only stands around to respond to codes) cannot meet the research standards of high quality CPR for very long. Heck we can train our staff on VAMs or RQI all day long and healthcare, at best, will only increase the survival rate by 1-5%. Here's a few highlights supporting eCPR:

  • Go Deep - A study of college aged, male students show they started out going 2 inches deep but at 1 one minute into the event participant's compressions were well under 2 inches deep. Also of the publish date the average age of a RN is a 48 y/o female. Research and my own antidotal evidence shows the workforce is not able to actually achieve proper compression deep for even one minute.
  • Minimize Pauses – The reality is any break (even one pause) yields a 50% reduction in better outcomes. Sounds a bit impossible right? I mean don't touch the patient while you shock, right?
  • Go Fast – The best outcome is when we do 125 compressions/minute. But keep in mind sustaining 125 compressions per minute, on average, can only be done for 45 seconds. Also what's the average age of the RN workforce?

If only we had some sort of device that would help us do great chest compressions. (Wink, Wink). Our next CPR blog entry will address various chest compression devices and how eCPR addresses the CPR gaps. 

ECMO Unit at Beside Bed

ECMO Circuit

Pit Crew CPR

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