Emerging treatments

Extracorporeal cardiopulmonary resuscitation

Extracorporeal cardiopulmonary resuscitation (ECPR) may be an option to increase survival after out-of-hospital cardiac arrest (OHCA). A single-centre randomised controlled trial (RCT) found that patients treated with early extracorporeal membrane oxygenation had increased survival rates compared with those receiving standard care; however the trial was small and was stopped early.[112] A multicentre RCT of 160 patients found that ECPR and conventional CPR had similar effects on survival with a favourable neurological outcome.[113] It is uncertain which patients should be selected to receive ECPR. It also is not clear whether transporting a larger number of patients in cardiac arrest to rapid triage for extracorporeal membrane oxygenation treatment might adversely impact overall survival rates for OHCA, due to the association of intra-arrest transport with worse outcomes.[51][112]​​ In 2022, the American Academy of Emergency Medicine stated there is currently insufficient evidence to recommend use of ECPR over standard advanced cardiac life support, whereas the American Heart Association guidelines and 2024 International Liaison Committee on Resuscitation consensus offer a weak recommendation that ECPR can be considered as rescue therapy in select patients when conventional cardiopulmonary resuscitation methods are failing, in settings in which this can be implemented.[54][87]​​[112][114]

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