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Extracorporeal cardiopulmonary resuscitation probably good, but adoption should not be too fast and furious!
  1. Clifton W Callaway1⇑,
  2. Kjetil Sunde2
  1. 1 Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, USA
  2. 2 Department of Anesthesiology, Division of Emergencies and Critical Care, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Clifton W Callaway, Department of Emergency Medicine, University of Pittsburgh, 400A Iroquois, 3600 Forbes Avenue Pittsburgh, PA 15260, USA; callawaycw{at}upmc.edu

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Two retrospective registry studies (case series) in this journal report on outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA).1 2 We can learn from the experiences of these investigators about the implementation of a complex life-saving procedure in the ED. However, it is important to put these data into context before deciding whether to imitate their programmes.

Current survival after OHCA averages about 12% in North America and Europe,3 but with large regional differences.4 Mortality occurs in three phases. First, the majority of the deaths occur because the heart cannot be re-started.5 Second, among patients in whom circulation is restored, some 20%–30% of patients die within the first few days due to an irreversible haemodynamic and/or myocardial dysfunction.6 Third, when surviving the first few days, the majority of patients die within the following days in comatose status due to the severity of the brain injury.6 7 Conceptually ECPR promises to eliminate the first wave of mortality, because mechanical circulation replaces spontaneous circulation. If this …

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