[Extracorporeal resuscitation-criteria, prerequisites, outcome : A reality check]

In select patients, in whom conventional cardiopulmonary resuscitation (cCPR) fails to re-establish circulation, the 2021 European Resuscitation Council guidelines suggest considering extracorporeal resuscitation (eCPR) as a rescue therapy in settings in which it can be implemented. eCPR is becoming established during refractory cardiac arrest as a bridge-to-therapy for diagnosis and treatment of reversible causes of cardiac arrest, such as myocardial infarction, pulmonary embolism, accidental hypothermia, overdose with cardiotoxic substances, and acute hypoxia. Patient selection criteria comprise prognostic characteristics of cardiac arrest such as witnessed status, resuscitation efforts within 5 min, shockable initial rhythm, and characteristics of effective cCPR such as signs of life during resuscitation, persistent ventricular fibrillation, intermittent episodes of spontaneous circulation or end-tidal CO₂ levels constantly > 10 mm Hg, patient age and health status. The timeframe from cardiac arrest to eCPR is a major contributor for neurologically favourable survival and should not exceed 60 min according to current guidelines. This may be achieved with an efficient "load & go" strategy, including early patient selection and rapid transport with ongoing mechanical cCPR to the eCPR centre, or with a prehospital eCPR strategy. Two randomized controlled eCPR trials demonstrated survival rates of 43% and 31.5% in patients with refractory ventricular fibrillation and cardiac-origin cardiac arrest, respectively. Whether these results are generalizable outside such highly specialized centres, and which prehospital and in-hospital strategy is best for which patients, remains to be determined in future studies.