Rapid Transport to Extracorporeal CPR: Urging Caution Prior to Implementation

Out-of-hospital cardiac arrest (OHCA) has survival that remains near 10% despite years of research and advancements in care. Extracorporeal cardiopulmonary resuscitation (ECPR) has been explored as an option for patients who suffer OHCA and are refractory to traditional therapies. In nearly every system that implements ECPR for OHCA, there is a requirement to incorporate intra-arrest transport (IAT). There are three major randomized controlled trials which have evaluated the role of ECPR in OHCA. These include ARREST, INCEPTION, and Prague OHCA. While ARREST has the strongest data to support ECPR, it includes only 30 patients. The larger trials such as INCEPTION and Prague OHCA did not show statistically significant results in favor of ECPR. Each trial has a unique study design and statistical analysis.The current evidence is not strong enough to support widespread adoption of ECPR into the prehospital systems of care. Examining the statistical pitfalls, potential biases, and methodological confounders of the existing ECPR literature against the background of previously reported data surrounding IAT─the full impact of effect of ECPR cannot exclude consideration of the impact of the effect of IAT. As more data is needed to better understand the full impact of implementing ECPR into a system of care, we encourage caution and thoughtful analysis to leaders who may be considering the addition of ECPR into an existing system of care. ECPR shows early promise for select patients. The development of an ECPR system is complex and has numerous facets, typically including the incorporation of early IAT for OHCA. At this time, more studies are needed on the full impacts of implementing ECPR into a system of care for OHCA.