1, 19, 20
Standard ACLS
Early ECMO-facilitated resuscitation
Single centre, phase 2, 30 patients, stopped early at an efficacy boundary. Highly selected population within a mature, high-volume ECPR system. Early stopping inflates effect size.
Out-of-hospital cardiac arrest with refractory ventricular fibrillation or pulseless VT, no ROSC after three shocks, age 18-75
Survival to hospital discharge
6/14 (43%) vs 1/15 (7%); posterior probability of ECMO superiority 0.9861, crossing the prespecified 0.986 efficacy boundary
It does not establish generalisability to other systems, and the effect estimate should be regarded as an upper bound.
Within a mature single-centre system, an ECMO-facilitated pathway for refractory shockable OHCA produced a large survival difference.