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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 …