Helicopter Transport Expands ECPR Access for Rural Refractory Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) remains a formidable clinical challenge, with low survival rates, especially in refractory cases where standard resuscitation fails [1, 2]. For select patients, particularly those with an initial shockable rhythm, extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes [3, 4, 2, 5]. ECPR, the use of veno-arterial extracorporeal membrane oxygenation during cardiac arrest, has been associated with a greater likelihood of favorable neurologic outcomes in some analyses (odds ratio: 1.84; 95% confidence interval: 1.14 to 2.99) [6]. However, its benefit is critically time-dependent, with shorter low-flow times, the interval from collapse to ECPR initiation, linked to better survival [7]. This requirement for rapid intervention at a specialized center creates a significant barrier to access for patients in rural or geographically distant areas, a challenge a recent study sought to address [8].