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In ECPR the mechanical benefit of ultrasound is a time benefit, and time is the dominant modifiable determinant of survival, so a procedural gain converts into an outcome gain in a way it does not in elective femoral access.
Cannulation without real-time ultrasound
DOI 10.1016/j.resuscitation.2023.109927
Real-time ultrasound-guided cannulation
Retrospective registry; propensity matching cannot adjust for operator skill or for why ultrasound was chosen; Japanese practice; unblinded time measurement.
Shorter time to ECMO flow with real-time ultrasound guidance (about 2.5 minutes). No demonstrated difference in vascular complication rate in the matched analysis.
SAVE-J II registry; adult ECPR for out-of-hospital cardiac arrest; 443 propensity-matched pairs