Extracorporeal cardiopulmonary resuscitation for out of hospital refractory cardiac arrest

Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended for the treatment of refractory cardiac arrest in the absence of return of spontaneous circulation despite optimal conventional cardiopulmonary resuscitation throughout the chain of survival. The aim of this second line of therapy is to restore adequate organ perfusion, especially to the brain, by replacing circulatory and respiratory functions while the cause of cardiac arrest is sought for and treated. As summarized by international guidelines, ECPR should be delivered by specialized teams, for selected patients, within a strict timeframe to improve the probability of neurologically intact survival. Anticipating patient pathway for refractory out of hospital cardiac arrest patients, in the prehospital setting and in-hospital with coordinated multidisciplinary care is a key element for the good management of patients treated with ECPR. The objective of this review is to describe current data on ECPR for the treatment of refractory cardiac arrest, with a focus on the findings from the randomized studies on ECPR for out of hospital cardiac arrest, although they are limited in number and methodologically very different, while outlining which patients should be treated with ECPR, as well as when and how ECPR should be implemented to increase the probability of neurologically intact survival.