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INTRODUCTIONBackgroundOut‐of‐hospital cardiac arrest (OHCA) remains a considerable global challenge with unfavorable neurological outcomes, despite advances in its management.1 Implementation of veno‐arterial extracorporeal membrane oxygenation (ECMO), often referred to as extracorporeal cardiopulmonary resuscitation (ECPR), during cardiac arrest has surfaced as a suitable therapeutic strategy for adult OHCA.2 Although ECPR may be a promising treatment, special considerations regarding indications for ECPR should be given in terms of cost‐effectiveness, resource use, and ethical issues.3 To date, it is still unclear who would most benefit from ECPR.4,5 Previous research demonstrated that time matters greatly in ECPR: shorter time span from collapse to ECPR initiation was associated with better outcomes.6,7ImportanceMeanwhile, early prehospital advanced life support (ALS), including epinephrine administration or advanced airway, was associated with higher survival rates after OHCA.8,9 In Japan, only specially trained emergency medical services (EMS) personnel are authorized to perform ALS under real‐time medical direction by physicians.10 As such, collaboration and integration of prehospital and in‐hospital management are crucial when activating the ECPR team and immediately establishing ECMO support for appropriate candidates. At present, however, whether there is a beneficial effect of prehospital ALS rather than prompt transport without ALS on outcomes in patients, particularly those who receive ECPR, is
Journal of the American College of Emergency Physicians Open – Wiley
Published: Apr 1, 2023
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