The final part, we will talk about the extracorporeal cardiopulmonary resuscitation, so-called ECPR. Cardiopulmonary resuscitation, defined as a procedure that combines chest compression and artificial ventilation, in pulseless patient. The purpose of CPR, is to preserve intact brain function, to restore blood circulation, and to maintain air ventilation. Extracorporeal cardiopulmonary resuscitation, ECPR, sometimes we called ECMO-assisted CPR. It is a procedure that in emergent situation, we set up VA-ECMO under CPR situation. The CPR teen continuous compress the patient and the using artificial ventilation. Meanwhile, the surgeon do the cannulation and set up the ECMO, in the femoral artery and the femoral vein. In our hospital, National Taiwan University Hospital, we started ECPR program since 1994. Very, very earlier than other hospital in the world. No mater in hospital cardiac arrest or out of hospital cardiac arrest, we did ECPR in certain patients, if they meet criteria for ECMO. But before ECPR program, we have to prepare equipment. To prepare the ECMO cart. We have to put on all these. What do you need in mobile cart? The cannula, the [inaudible] , the operation garment, the operation instrument, or the suture materials, all the canulas in a mobile cart. So that, we can operate ECMO everywhere, no matter in operation room, in ICU, in general ward, in emergency room, in classroom. So in a mobile equipment, the ECMO cart, the dry priming, ready to use ECMO. We can rapid response to CPS situation. So this is the key point of ECPR program. In the ELSO registry report, in 2070, our hospital, National Taiwan University Hospital, already reported more than 500 ECPR. When compared with 3,000 ECPR in the ward registry. National Taiwan University Hospital, adult, ECPR, is about 50 percent worldwide. So, our hospital is also a leading centers in the study of ECPR. We reported in 2009, the ECPR, will improve in hospital cardiac arrest survival. By using ECMO, we can improve more than 20 percent survival in CPR situation. In 2014, we also reported a ECPR for all of hospital cardiac arrest. When compared with in-hospital cardiac arrest. The result of ECPR was nearly the same as the in-hospital cardiac arrest. Survival to discharge was 38 percent in OHCA patients, when compared with 31 percent in IHCA patients. The CPC performance, which means neurological status. The favorable neurological status, the status one or two patients. The percentage in number was nearly less than in the two groups. This means that, we can use the ECMO, CPR to rescue the patients, not only in hospital, but also out of hospital cardiac arrest situation. So ECPR can improve survival chance of in hospital cardiac arrest, as well as out of hospital cardiac arrest patients, when compared with conventional CPR. In conclusion, the key message of this lecture, the ECERS can provide temporary support for patients with cardiopulmonary value. The VA-ECMO, can partially support both heart and lung. The VV-ECMO support lung only. But the VV-ECMO can provide better gas exchange, when compared with VA ECMO. ECPR can improve survival chance, when compared with conventional CPR. At the end of this lecture, I will use the Sir Churchill's words. The future is unknowable, but the past should give us hope, especially in the COVID-19 pandemic era. Thank you very much. Thanks for your listening.
