ECMO for refractory cardiac arrest

Abstract

Sudden cardiac arrest is a potentially catastrophic event with an extremely high mortality rate. The poor prognosis is related to many factors linked to both the time before the return of spontaneous circulation and the care in the post-resuscitation period. The “life-support chain” concept and the continuous update of international guidelines over time improved the care of these patients in many aspects but with a modest impact on the final outcome. Extracorporeal support of the circulation was first attempted in the 1960s with primitive devices and uncertain utility. Advances in technology made possible the development of the “extracorporeal life-support” concept, and the extended application of ECLS allowed progressively improved outcomes. Extracorporeal circulation remains an uncommon therapy for highly selected patients, but we believe that it represents an important and valuable therapeutic option in patients suffering cardiac arrest, when this is performed by a well-trained team, on top of state-of-the-art conventional management.