Extracorporeal cardiopulmonary resuscitation: not why, but how

Extracorporeal cardiopulmonary resuscitation (ECPR) represents an important advance in the care of patients with cardiac arrest. 1 Kalra R Kosmopoulos M Goslar T Raveendran G Bartos JA Yannopoulos D Extracorporeal cardiopulmonary resuscitation for cardiac arrest. Curr Opin Crit Care. 2020; 26: 228-235 Crossref PubMed Scopus (21) Google Scholar Accordingly, many attempts have been made in observational studies and randomised controlled trials to define the mortality benefit of ECPR for patients with out-of-hospital and in-hospital cardiac arrest. However, the diversity in the approaches and settings within which ECPR protocols have been applied has predictably led to mixed outcomes. Despite promising outcomes in some expert settings, 2 Yannopoulos D Bartos J Raveendran G et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020; 396: 1807-1816 Summary Full Text Full Text PDF PubMed Google Scholar clinicians and scientists have been left wondering how to reconcile positive outcomes with other less positive data, 3 Yannopoulos D Bartos JA Aufderheide TP et al. The evolving role of the cardiac catheterization laboratory in the management of patients with out-of-hospital cardiac arrest: a scientific statement from the American Heart Association. Circulation. 2019; 139: e530-e552 Crossref PubMed Scopus (130) Google Scholar which suggest the lack of a survival benefit. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysisCompared with CCPR, ECPR reduced in-hospital mortality and improved long-term neurological outcomes and post-arrest survival, particularly in patients with IHCA. These findings suggest that ECPR could be considered for eligible patients with IHCA, although further research into patients with OHCA is warranted. Full-Text PDF