Chapter 19 — ECPR Principles

Opens Part IV. Deliberately contains NO selection criteria (Chapter 20 owns them). Organising argument: ECPR is a system whose output is time, and the three randomised trials are ordered by system maturity rather than biology — the key number being that INCEPTION had the shortest on-scene time of the three and the longest low-flow time, with the excess generated inside the hospital. Two controversies: the sixty-minute rule (prospective service target versus retrospective bedside refusal) and four meta-analyses of three trials giving point estimates 1.47–1.90 and opposite verdicts. Three retrieved-in-full sources: the trialists' three-trial comparison (EHJ ACC 2023), the Bayesian meta-analysis and the updated meta-analysis with TSA (both Critical Care 2024). All three trials read from abstracts and the trialists' paper — rows Verified = No. Numerical audit flagged three discrepancies and did not correct any: a backwards low-flow survival comparison in the ECPR textbook, a cerebral oximetry abstract contradicting its own conclusion, and two different INCEPTION delivery figures (52/70 and 46/70) published by the same group. A sixth bibliographic-metadata problem recorded (preprint DOI attached to a journal record); no identifier reconstructed. CURRENCY: the ELSO ECPR interim guidance (ASAIO J 2021;67:221-228) remains the only society statement and has not been updated for INCEPTION or the pooled IPD analysis — the largest currency gap in the book, and still read only second-hand through Red Book Ch 32.