Extracorporeal cardiopulmonary resuscitation (ECPR) is invasive and resource intense. Data suggesting a survival benefit in patients after OHCA and ECPR derive from retrospective registries and meta-analyses. In order to improve outcomes, ECPR teams have to be embedded into local emergency systems and refined towards a reduction in low-flow.

Survival rates after cardiac arrest are low. In this context, extracorporeal cardiopulmonary resuscitation (ECPR) has been first introduced as ultima ratio in 1966.

Almost 6 decades later, more than 15,000 ECPR cases are registered in the Extracorporeal Life Support Organization (ELSO) registry [2, 3] with a survival rate of 30%.

This review will discuss the background, indications, challenges, and limitations of ECPR.

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