The use of veno-arterial extracorporeal membrane oxygenation as extracorporeal cardiopulmonary resuscitation in patients suffering out-of-hospital cardiac arrest, largely increased in the last decade despite evidence supporting this practice being limited to non-randomized studies. However, between 2020 and 2023, four randomized studies were published comparing extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation with controversial findings that triggered great debates. In this controversy, we discuss merits and pitfalls, and provide a critical interpretation of the available evidence from randomized trials on the use of extracorporeal cardiopulmonary resuscitation, with a particular focus on the recent multi-center INCEPTION trial.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Cardiovascular Division University of Minnesota Minneapolis Minnesota USA

Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy

Department of Cardio Thoracic Surgery Heart and Vascular Centre Maastricht University Medical Centre Cardiovascular Research Institute Maastricht Maastricht The Netherlands

Department of Intensive Care Hôpital Universitaire de Bruxelles Brussels Belgium

Department of Respiratory Medicine Paracelsus Medical University Nuremberg Germany

Faculty of Medicine Vita Salute San Raffaele University Milan Italy

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