Extracorporeal Cardiopulmonary Resuscitation in Latin America: It is Not All about the Money

When conventional cardiopulmonary resuscitation fails to restore circulation after cardiac arrest, the window for survival with a favorable neurological outcome narrows rapidly. Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a potential strategy to prolong this window by rapidly establishing circulatory and respiratory support through venoarterial extracorporeal membrane oxygenation (VA-ECMO). According to the Extracorporeal Life Support Organization (ELSO), ECPR is defined as the rapid initiation of VA-ECMO in patients with refractory cardiac arrest who do not achieve sustained return of spontaneous circulation (ROSC) through conventional resuscitation.

ECPR has become an established rescue strategy for refractory cardiac arrest in both in-hospital (IHCA) settings and selected out-of-hospital cases (OHCA) referred to specialized centers. Outcomes after cardiac arrest differ substantially between these settings. Patients with IHCA typically experience better survival and neurological outcomes than those with OHCA, primarily due to earlier recognition, immediate high-quality CPR, and rapid access to advanced interventions such as defibrillation and invasive monitoring. Conversely, OHCA is frequently associated with delays in recognition and treatment, prolonged no-flow and low-flow intervals, and variability in prehospital care. Timely intervention and rapid access to advanced therapies remain critical determinants of survival and neurological recovery.

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