Extracorporeal CPR
A systematic review by Holmberg et al in 201814 concluded that there is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies reviewed was very low.
Last December the ARREST Trial published their results. This is a phase 2, single centre, open-label, adaptive, safety and efficacy randomised clinical trial comparing early ECMO facilitated resuscitation compared with standard ACLS treatment for Refractory Ventricular Fibrillation. 30 were randomly assigned to standard ACLS treatment (n=15) or to early ECMO-facilitated resuscitation (n=14 with one drop out). The results were impressive, with survival to hospital discharge observed in one (7%) in the standard ACLS treatment group versus six (43%) of 14 in the early ECMO-facilitated resuscitation group.15