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Cardiac arrest
Prehospital ECPR linked to doubled arrest survival
Prehospital Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest
The New England Journal of Medicine · 2026-11-07 · Added 10 November 2026
A nationwide Dutch study compared HEMS with prehospital ECPR against conventional HEMS in adults 50 or younger with refractory out-of-hospital cardiac arrest and found 40% survival to discharge with ECPR versus 20% without, with better neurological outcomes at 6 months.
- Study type
- Cohort
- Design
- Nationwide nonrandomised comparative cohort (OnScene, Netherlands)
- Participants
- 231 adults ≤ 50 with refractory OHCA (144 ECPR-capable HEMS vs 87 conventional)
- Main finding
- Survival to discharge 40% with ECPR vs 20% without (OR 2.72, 95% CI 1.59–4.66); favourable neurological outcome at 6 months 36% vs 13% (OR 4.22, 95% CI 2.82–6.32); 32 adverse events with ECPR vs 11
- Caveat
- Not randomised — patients attended by ECPR-capable HEMS may differ systematically, and the ECPR group had nearly three times the adverse events
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). Prehospital ECPR runs from physician-staffed helicopter services — an intensive care tier well beyond Australian road practice — so this informs where the evidence is heading rather than what crews do today.
Learning goal
Weigh the benefits and harms of prehospital ECPR for young adults in refractory cardiac arrest.
More
- Topic: Cardiac arrest
- Daily scan: 10 November 2026
- Podcast: Paramedic Papers Daily, 10 November 2026
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