Post-cardiac arrest extracorporeal life support

Sudden cardiac arrest is a complex, life-threatening event involving a multidisciplinary approach. Despite the use of conventional cardiopulmonary resuscitation, survival rate continues to be low for both in-hospital and out-of-hospital cardiac arrest. In refractory cardiac arrest, defined by the absence of return of spontaneous circulation despite resuscitation manoeuvres, mortality approaches 100%. In the last years, an increasing number of case series, and few propensity-matched cohort studies have reported encouraging results on the use of venoarterial extracorporeal membrane oxygenation for refractory cardiac arrest. Extracorporeal circulation ensures an adequate blood flow, to perform diagnostic and therapeutic interventions even before a return of spontaneous circulation is achieved and to rest the heart by unloading the ventricle while ensuring myocardial perfusion after return of spontaneous circulation. This study reviews the rational, indications, evidence and management of extracorporeal support for cardiac arrest.