ECMO in cardiac arrest

Cardiac arrest (CA) is a major cause of death and a public health problem. Conventional cardiopulmonary resuscitation (CPR) is to date the only effective resuscitation technique capable of improving the prognosis of patients. ECMO is a heavy and relatively expensive technique that requires expertise. It cannot therefore be developed in all centres and must be reserved for centres with a high volume of implantation. This technique combined with CPR is called extracorporeal cardiopulmonary resuscitation (ECPR). It allows haemodynamic and respiratory stabilisation of patients with CA refractory to conventional CPR techniques and allows, by maintaining an organ perfusion, to treat the cause of the CA. However, based on current knowledge, it is not possible to recommend the routine use of ECPR in all patients with refractory CA. It is therefore essential to properly select the patients who can benefit from this technique. It is certainly by minimising the duration of the no-flow, by providing high quality CPR, by reducing the duration of the low-flow and by optimising access to ECPR that survival in refractory CA could be improved. The main objective in the management of these patients is to allow them to survive with an acceptable neurological state.