Authors response: Extracorporeal cardiopulmonary resuscitation probably good, but adoption should not be too fast and furious!

Callaway and Sunde1 are right when they advise caution in adoption of extracorporeal cardiopulmonary resuscitation (ECPR) given the varying definitions of what ECPR constitutes. However, we believe ECPR is not coming ‘too fast and furious’ but rather like a Formula One car, dependent on focused high performance teams, bespoke with narrow specifications and at the cutting edge.

Current survival for cardiac arrest by conventional cardiopulmonary resuscitation (CCPR) is indeed dismal at around 10%.2 ECPR has led to improved outcomes compared with CCPR in many regions.3–6 ECPR consideration is in some ways analogous to resuscitative thoracotomy (RT) in trauma. Despite moderate quality of evidence, RT is strongly recommended in pulseless penetrating torso trauma with signs of life in ED.7 The same can be said for ECPR.

A large randomised controlled trial (RCT) of ECPR versus CCPR is problematic due...

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