The increased accessibility of extracorporeal membrane oxygenation following the COVID-19 pandemic and the publication of the first randomized trial of extracorporeal cardiopulmonary resuscitation (ECPR) prompted the National Heart, Lung, and Blood Institute to sponsor a workshop on ECPR. Two more randomized trials have since been published in 2022 and 2023. Based on the combined findings and review of the evidence, an international panel of authors identified gaps in science, inequities in care and diversity in outcomes, and suggested research opportunities and next steps. The science pertaining to ECPR would benefit from the United States contributing uniform data to existing registries and sharing common data with the ELSO (Extracorporeal Life Support Organization) international registry to increase the sample size for observational research. In addition, well-designed efficacy trials, recruiting across different regions of care evaluating long-term follow-up, including patient reported outcomes, cost effectiveness, and equity measures, would contribute significantly to the body of science. Workshop participants defined the population of patients with out-of-hospital cardiac arrest most likely to benefit from ECPR. ECPR-eligible patients include those aged 18 to 75 years functioning independently without comorbidity; before suffering a witnessed out-of-hospital cardiac arrest and without any obvious cause of the cardiac arrest; presenting in a shockable rhythm and transported with mechanical cardiopulmonary resuscitation to an ECPR-capable institute within 30 minutes, which is recommended after 3 rounds of advanced life support treatment without return of spontaneous circulation. There are significant inequities in out-of-hospital cardiac arrest care that need to be addressed such that outcomes are optimized for each target region before implementing ECPR in a clinical or implementation trial.

American Heart Association Dallas TX USA

Anesthesiology and Critical Care Medicine and Pediatrics Johns Hopkins University School of Medicine Baltimore MD USA

Cardiology Sarver Heart Center University of Arizona Tucson AZ USA

Cardiology University of Minnesota Minnesota Resuscitation Consortium Minneapolis MN USA

Cardiothoracic Critical Care Division of Cardiothoracic Surgery and Department of Surgery and Department of Emergency Medicine University of Utah Health Salt Lake City UT USA

Department of Emergency Medicine St Paul's Hospital and the University of British Columbia Centre for Advancing Health Outcomes Vancouver BC Canada

Department of Family Medicine and Community Health and Population Health Sciences Duke University School of Medicine Durham NC USA

Department of Internal Medicine 2 Cardiovascular Medicine General University Hospital and 1st Medical School Charles University Prague Czech Republic

Division of Cardiovascular Sciences NHLBI NIH Bethesda MD USA

Emergency Medicine Anesthesiology and Critical Care Center for Digital Health University of Pennsylvania Philadelphia PA USA

Emergency Medicine Emory University Atlanta GA USA

Emergency Medicine Medical College of Wisconsin Milwaukee WI USA

Emergency Medicine Medicine University of Toronto Emergency Services Sunnybrook Health Sciences Centre Toronto Ontario Canada

Emergency Medicine University of Pittsburgh Pittsburgh PA USA

Emergency Medicine University of Utah Medical Center Salt Lake City UT USA

Intensive Care Medicine Sorbonne Université APHP La Pitié Salpêtrière Hospital Paris France

Office of Science and Medicine Office of the Assistant Secretary for Health Washington DC USA

Surgery and Emergency Medicine University of Texas Southwestern Dallas TX USA

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