Table 3.

Problems and Pitfalls in Qualification for ECLS Rewarming

The clinical factors usually considered as contraindications for ECPR in normothermic CA (asystole, unwitnessed CA, unknown no-flow duration, prolonged CPR duration, advanced age) ARE NOT a contraindication for ECLS rewarming in AHCA patients

Blood sampling should avoid hemolysis, and minimize trauma to femoral vessels

Inclusion criteria for ECLS rewarming should not be based on a single potassium level. Extreme serum potassium levels are possible. A second blood sample obtained at a different site and verifying measurement may be reasonable

If some variables of the HOPE score are not clear (e.g., the presence or absence of asphyxia), taking into account the variable that will lead to the highest survival probabilities when calculating the HOPE score will offer the best chances of survival to the patient

Concomitant trauma, especially traumatic brain injury is not an absolute contraindication for ECLS rewarming. Anticoagulation free ECLS run is possible74

AHCA, accidental hypothermia cardiac arrest; CPR, cardiopulmonary resuscitation; ECLS, extracorporeal cardiac life support.