Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.

• Klíčová slova
• Cardiac arrest, Extracorporeal cardiopulmonary resuscitation, Extracorporeal membrane oxygenation, IHCA, OHCA,
• MeSH
• analýza nákladů a výnosů MeSH
• dospělí MeSH
• kardiopulmonální resuscitace * metody   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• zástava srdce mimo nemocnici * terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).

UNLABELLED: Diese Leitlinien des European Resuscitation Council (ERC) für den Kreislaufstillstand unter besonderen Umständen basieren auf dem 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. Dieses Kapitel enthält Leitlinien zu den Modifikationen der lebensrettenden Basismaßnahmen und erweiterten lebensrettenden Maßnahmen zur Vorbeugung und Behandlung von Kreislaufstillständen unter besonderen Umständen; insbesondere spezielle Ursachen (Hypoxie, Trauma, Anaphylaxie, Sepsis, Hypo‑/Hyperkaliämie und andere Elektrolytstörungen, Hypothermie, Lawinengeschehen, Hyperthermie und maligne Hyperthermie, Lungenembolie, Koronarthrombose, Herzbeuteltamponade, Spannungspneumothorax, Giftstoffe), spezielle Umstände (Operationssaal, Herzchirurgie, Herzkatheterlabor, Dialyseeinheit, Zahnkliniken, Transport während des Flugs, Kreuzfahrtschiffe, Sport, Ertrinken, Großschadensereignisse) und spezielle Patientengruppen (Asthma und chronisch obstruktive Lungenerkrankung, neurologische Erkrankungen, krankhafte Adipositas, Schwangerschaft). ZUSATZMATERIAL ONLINE: Die Online-Version dieses Beitrags (10.1007/s10049-021-00891-z) enthält das originale Zusatzmaterial aus dem Artikel in Resuscitation. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

• Klíčová slova
• Modifications of life support, Reversible causes, Special causes, Special patient groups, Special settings,
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH