19, 20, 77
The conceptual backbone of Chapter 19. ARREST and PRAGUE-OHCA tested EFFICACY under near-ideal conditions; INCEPTION tested EFFECTIVENESS under ordinary ones; the results are complementary, not contradictory. The authors' conclusion: excellent results require a very high level of dedication and strict selection, and pragmatic implementation does not necessarily improve outcome. Centres should critically assess their own setting, logistics, performance and outcomes.
Conventional CPR / continued on-scene ALS
DOI 10.1093/ehjacc/zuad071
ECPR
A narrative comparison by the trials' own authors, not a systematic analysis. Two internal inconsistencies recorded in Chapter 19: PRAGUE-OHCA's mean low-flow time given as 62 min in a table and 61 min in the text, and an INCEPTION delivery figure (52/70) that differs from the same group's own secondary analysis (46/70). The ELSO Registry volume figure it cites was not retrieved independently.
Side-by-side design, population, logistics and outcome data for all three trials, including mean low-flow times (59, 62 and 74.7 min), mean on-scene times (23, 13 and 13 min), door-to-ECMO times (12, 12, and 16+20 min), ECPR delivery rates (80%, 66%, 74%), control-arm crossover (0%, 8%, 5%), annual ECPR caseload (18/year, 12/year, 0.29 per centre per month) and catchment populations (3.5 M, 1.25 M, ~800,000 per centre). Cites an ELSO Registry analysis giving an adjusted odds ratio for hospital survival after ECPR of 0.36 in hospitals performing fewer than 10 ECPR procedures per year.
A structured comparison of ARREST, PRAGUE-OHCA and INCEPTION written jointly by investigators from all three trials, classified against the PRECIS-2 pragmatic-explanatory continuum.