In July, we explored how Extracorporeal Cardiopulmonary Resuscitation (ECPR) is revolutionizing resuscitation, with survival rates quadrupling compared to traditional CPR. While much research has focused on ECPR’s role in out-of-hospital cardiac arrests, a new study from UCLA examines outcomes in cardiac arrests that occur in the hospital, specifically those that occur during the perioperative period.

 

The perioperative period refers to the time during or immediately surrounding surgical procedures, interventional cardiology procedures, or other invasive interventions. This is a particularly high-risk period for cardiac arrest, with approximately 5 arrests occurring per 10,000 surgical patients.

 

The risk is even higher in elderly patients and those undergoing cardiac, thoracic, or head and neck procedures. The cardiac catheterization laboratory, in particular, sees a higher frequency of arrests compared to the operating room, largely due to the complex nature of cardiac interventions and the unstable condition of many cardiac patients.

The Gap Between Resources and Results

One might assume that having a cardiac arrest in a hospital setting—particularly in a cardiac catheterization lab with immediate access to specialized equipment and trained personnel—would result in better outcomes. However, the reality is sobering: only 37.1% of patients who experience cardiac arrest in the cath lab survive to be discharged.

This is where the UCLA study offers valuable insights. Even in a hospital setting, initiating ECPR can be a complex and time-consuming process without proper preparation and protocols. The UCLA team addressed this challenge by developing a comprehensive perioperative ECPR program that enabled them to initiate support within 5-10 minutes of arrest—a remarkable achievement that demonstrates how organized preparation can overcome the typical delays in ECPR deployment.

 

The UCLA team examined their experience with 33 patients who received perioperative ECPR over a 7-year period. Of these cases, three-quarters occurred in the cardiac catheterization laboratory, with the remainder taking place in the operating room or interventional radiology suite. The results were striking: 57% of patients survived to discharge, representing a significant improvement over the traditional survival rate of 37.1% for cath lab arrests.

 

The key insight from the UCLA study is that a well-developed program with clear protocols for early activation and careful patient selection elicits positive results. The UCLA team demonstrated that bridging the gap between having resources and effectively deploying them requires a thoughtful and systematic approach to implementation.

Translating Success into Standard Practice

As we discussed in our previous article, the American Heart Association has already recognized ECPR’s importance in their 2024 guidelines. This new research suggests we should be thinking even more broadly about where and how we implement ECPR programs. Specifically, it highlights the need to strengthen and optimize our ECPR programs for rapid deployment in the hospital setting. The perioperative setting, with its unique combination of high-risk procedures and immediately available medical expertise, may represent the perfect environment for maximizing ECPR’s life-saving potential.

 

The UCLA study reinforces what we’ve known about ECPR’s effectiveness while highlighting a specific context where its benefits can be maximized. For healthcare institutions considering or expanding their ECPR programs, this research provides compelling evidence for developing comprehensive perioperative protocols. It’s not just about having the capability – it’s about building systems that ensure this life-saving intervention is available and optimally deployed when those critical moments arise.