Wolf Creek XVII Part 7: Mechanical circulatory support

Cindy H Hsu; George Trummer; Jan Belohlavek; Demetris Yannopoulos; Jason A Bartos

doi:10.1016/j.resplu.2023.100493

Wolf Creek XVII Part 7: Mechanical circulatory support

Resusc Plus. 2023 Nov 1:16:100493. doi: 10.1016/j.resplu.2023.100493. eCollection 2023 Dec.

Authors

Cindy H Hsu^{1

2}, George Trummer³, Jan Belohlavek⁴, Demetris Yannopoulos⁵, Jason A Bartos⁵

Affiliations

¹ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
² The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA.
³ Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany.
⁴ 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
⁵ Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.

Abstract

Introduction: Failure to restore spontaneous circulation remains a major cause of death for cardiac arrest (CA) patients. Mechanical circulatory support, specifically extracorporeal cardiopulmonary resuscitation (ECPR), has emerged as a feasible and efficacious rescue strategy for selected refractory CA patients.

Methods: Mechanical Circulatory Support was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of CA resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category.

Results: Top 5 knowledge gaps included optimal patient selection, pre-ECPR treatments, logistical and programmatic characteristics of ECPR programs, generalizability and effectiveness of ECPR, and prevention of reperfusion injury. Top 5 barriers to translation included cost/resource limitations, technical challenges, collaboration across multiple disciplines, limited patient population, and early identification of eligible patients. Top 5 research priorities focused on comparing the outcomes of prehospital/rapid transport strategies vs in-hospital ECPR initiation, implementation of high-performing ECPR system vs standard care, rapid patient identification tools vs standard clinical judgment, post-cardiac arrest bundled care vs no bundled care, and standardized ECPR clinical protocol vs routine care.

Conclusion: This overview can serve as an innovative guide to transform the care and outcome of patients with refractory CA.

Keywords: Cardiac arrest; Extracorporeal cardiopulmonary resuscitation; Mechanical circulatory support; Wolf Creek Conference.

Publication types

Review