Current Opinion in Critical Care · 3 authors, 3 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This narrative review summarizes recent randomized controlled trials and observational studies on extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest. It concludes that ECPR can improve survival in selected patients within highly dedicated systems, but widespread sustainable implementation remains uncertain.
This narrative review examines the current evidence for ECPR in refractory out-of-hospital cardiac arrest (OHCA). The authors describe diverging results across randomized controlled trials, attributed to differences in selection criteria and study design. Single-center studies with extraordinary expertise consistently achieve a low-flow time of approximately 60 minutes, but such results are rarely reproduced outside these centers. Strict patient selection can improve outcomes while simultaneously limiting caseload. Preliminary data suggest that avoiding hyperoxia postresuscitation may improve outcomes. The review identifies several implementation challenges, including the need for dedicated systems, financial investment, and adequate caseload. Cerebral injury and therapy-refractory shock remain the leading causes of death after ECPR. The authors note that neuroprognostication timing after ECPR remains debated, with withdrawal from life-sustaining therapy occurring in more than half of non-surviving patients.
