Extracorporeal cardiopulmonary resuscitation for refractory OHCA: lessons from three randomized controlled trials—the trialists’ view
Johannes F.H. Ubben, Samuel Heuts, Thijs Delnoij, Martje M. Suverein, Anina F. van de Koolwijk, Iwan C.C. van der Horst, Jos G. Maessen, Jason A. Bartos, Petra Kaválková, Daniel Rob, Demetris Yannopoulos, Jan Bělohlávek, Roberto Lorusso, Marcel C.G. van de Poll
Abstract
Extracorporeal cardiopulmonary resuscitation is a promising treatment for refractory out-of-hospital cardiac arrest. Three recent randomized trials (ARREST trial, Prague OHCA study, and INCEPTION trial) that addressed the clinical benefit of extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest yielded seemingly diverging results. The evidence for extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest, derived from three recent randomized controlled trials, is not contradictory but rather complementary. Excellent results can be achieved with a very high level of dedication, provided that strict selection criteria are applied. However, pragmatic implementation of extracorporeal cardiopulmonary resuscitation does not necessarily lead to improved outcome of refractory out-of-hospital cardiac arrest. Centres that are performing extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest or aspire to do so should critically evaluate whether they are able to meet the pre-requisites that are needed to conduct an effective extracorporeal cardiopulmonary resuscitation programme.