Extracorporeal Life Support (ECLS)

Different roles of ECLS:

1. Cardiogenic Shock
2. ECLS for ARDS
3. Refractory cardiac arrest (see below)

ECLS for Refractory Out-of-hospital Cardiac Arrest

1. The ARREST trial showed superiority of ECLS in a small single-centre trial (43% vs 7% survival to discharge) and was therefore terminated for superiority.
2. The INCEPTION (NEJM 2023) RCT in the Netherlands examined the role of extracorporeal CPR in patients with OHCA with an initial ventricular rhythm without ROSC after 15 minutes of standard ACLS resuscitation. Patients in the treatment group were cannulated on arrival to hospital. From 134 patients, there was no significant difference in the primary outcome of survival with favourable neurologic outcome between the two groups.

Therefore, at this time, salvage ECLS for refractory OHCA is not clearly indicated.