ECPR boosts cardiac arrest survival rates
A recent review in the Indian Journal of Critical Care Medicine highlights salvage extracorporeal cardiopulmonary resuscitation (ECPR). It shows global survival rates of 30% in adults and 42% in neonates.
The study’s authors present a plan to tackle healthcare challenges in India. Cardiac arrest patients often die despite advanced cardiac life support (ACLS). They propose ways to introduce ECPR systemwide.
Global Survival Advantage
Extracorporeal life support boosts survival to hospital discharge. It achieves 30% for adults and 42% for infants worldwide. This outperforms South West Asia and Africa, where adult survival is 22% and neonatal survival is 44%.
Key international studies, like the Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest trial, where ECPR produced a 43% survival rate compared to just 7% with conventional methods, and the Prague Out-of-Hospital Cardiac Arrest study (31.5% vs. 22.0% at six months) demonstrate significant neurological and survival advantages.
Challenges in India
The analysis points to serious prehospital deficiencies in India, such as bystander CPR rates below 1.3%, public awareness of CPR at just 2%, and paramedics available in only 34% of hospital ambulances.
The report indicates that among approximately 54 active ECMO centers in India, only 20 are formally registered with the Extracorporeal Life Support Organization (ELSO), with inexperienced facilities citing equipment shortages and financial constraints as primary barriers at 50% each.
Considering the current state of ECPR in India, establishing a centralized national registry and conducting context-specific trials will provide evidence to refine local practices and improve survival rates.
The researchers advocate for a phased rollout, starting with in-hospital cardiac arrest (IHCA) cases and major urban medical centers to develop consistent protocols before expanding to broader regional networks.
Doctors could improve survival by adopting standardized patient selection criteria. Focus on individuals under 60 with witnessed cardiac events, initial shockable rhythms, and less than 60 minutes of low blood flow. Ensure pre-loaded extracorporeal systems are ready in emergency care units.
