Extracorporeal Life Support (ECLS) for Critically Ill Patients in the Emergency Department

Extracorporeal life support (ECLS) is a set of therapies that focus on oxygenation, carbon dioxide removal, and circulatory support to provide adequate oxygen delivery to the tissues for the time needed to restore damaged cardiac or pulmonary function, identify therapeutic options, or plan a transplantation or long-term mechanical support implantation. ELCS is, at present, a highly specialized therapy, and the possibility to deliver it in the emergency department depends largely on the existence of an ECLS program in the center or from a retrieval team arriving from a hub center. Different configurations allow for different indications. Namely, ECLS with veno-arterial cannulation provides circulatory and respiratory support, while in its veno-venous configuration, it delivers uniquely respiratory assistance. The main indication for the use of ECLS in the emergency department is represented by cardiogenic shock, a life-threatening clinical syndrome characterized by cardiac dysfunction resulting in end-organ hypoperfusion, tissue hypoxia, and increased lactate levels. ECLS can also be applied in patients suffering from cardiac arrest in whom conventional cardiopulmonary resuscitation is unsuccessful in achieving a sustained return of spontaneous circulation. Finally, indications for ECLS in respiratory failure in the emergency department are limited, since most patients are generally managed with mechanical ventilation upon presentation, while the indication for ECLS is commonly a second line. So far, when an ECLS is initiated in an emergency department, a highly specialized multidisciplinary team is required. However, future directions imply the development of portable, automated, and biocompatible devices to be easily used in a larger number of emergency departments.