Extracorporeal cardiopulmonary resuscitation for refractory OHCA: lessons from three randomized controlled trials-the trialists' view

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.

Keywords: Efficacy and effectiveness; Extracorporeal cardiopulmonary resuscitation; Randomized controlled trials; Review.

Figure 1

Study design assessment of the three randomized trials, according to the PRECIS-2 domains. Of note, the domain flexibility (adherence) was deemed not applicable, as adherence in ECPR treatment is not an issue. The omission of this domain in such interventions is also advocated by the PRECIS-2 authors. PRECIS-2, Pragmatic-Explanatory Continuum Indicator Summary 2.