ECPR for out-of-hospital cardiac arrest: more evidence is needed

Excerpt

The use of extracorporeal membrane oxygenation during cardiac arrest (extracorporeal cardiopulmonary resuscitation (ECPR)) has increased in recent years [1] after evidence emerged that it was associated with better outcomes than conventional CPR for in-hospital cardiac arrest [2‐4]. This success led some clinicians to attempt ECPR in highly selected patients who suffered out-of-hospital cardiac arrest (OHCA), often cannulating them on arrival in the emergency department [5]. One key determinant of the likelihood of survival in ECPR patients is the duration of CPR prior to cannulation [2, 3, 6, 7], so investigators inferred that the outcomes for OHCA patients might be improved by cannulation in the field (prehospital ECPR), thereby reducing the period of inadequate circulation. However, the logistic barriers to prehospital ECPR are formidable, including the difficulties inherent to undertaking complex medical procedures in a field setting, minimizing delays in cannulation without being indiscriminate about patient selection, as well as the resource consumption. Nonetheless, some hospital networks have created mobile intensive care units with prehospital ECPR capabilities [5]. …