Extracorporeal CPR in Out-of-Hospital Cardiac Arrest — Still on Life Support?

This editorial examines the current evidence and challenges surrounding extracorporeal CPR (ECPR) for out-of-hospital cardiac arrest, referencing key randomized trials: INCEPTION, ARREST, and the Prague study. Despite its theoretical benefit in reducing ischemic injury, ECPR showed no statistically significant outcome improvement over conventional CPR in multicenter trials, though all showed numerical trends favoring ECPR. Limitations include small sample sizes, early terminations, and unclear patient selection criteria. The authors emphasize that broad implementation remains premature and call for larger-scale studies with better stratification to identify patients most likely to benefit. Until then, the future of ECPR remains uncertain.

This editorial examines the current evidence and challenges surrounding extracorporeal CPR (ECPR) for out-of-hospital cardiac arrest, referencing key randomized trials: INCEPTION, ARREST, and the Prague study. Despite its theoretical benefit in reducing ischemic injury, ECPR showed no statistically significant outcome improvement over conventional CPR in multicenter trials, though all showed numerical trends favoring ECPR. Limitations include small sample sizes, early terminations, and unclear patient selection criteria. The authors emphasize that broad implementation remains premature and call for larger-scale studies with better stratification to identify patients most likely to benefit. Until then, the future of ECPR remains uncertain.