The ED ECPR Algorithm: A 3-Staged Approach
When patients present to the ED in the peri-arrest phases of cardiovascular collapse, decisive action by the emergency physician can make the difference between life and death. Additionally, critical information necessary to determine whether a patient is a candidate for aggressive intervention is often unavailable or becomes available piecemeal. At the same time, we know that successful neurologic outcomes are inversely associated with the time it takes to reestablish brain perfusion (either intrinsic perfusion with ROSC or extracorporeal perfusion with ECLS). Therefore, we developed a 3-stage algorithm for early initiation of ECPR at our institution.
The ECPR algorithm typically involves 2 physicians. With the first physician supervising ACLS (AKA the “code doc”), the second doctor is responsible for percutaneous femoral venous and arterial access (AKA the “line doc”). On average, it takes 20 to 30 minutes to complete all 3 stages, which provides enough time to allow the patient to achieve ROSC via traditional means. Concomitantly, the critical care ECLS nursing team is called, and the portable ECLS unit is brought from the intensive care unit to the ED. Here is a schematic: