Authors response: overcautious adoption of extracorporeal cardiopulmonary resuscitation

We agree with most points made by Burns and colleagues.1 In fact, their letter is an excellent example of the enthusiasm that surrounds extracoporeal cardiopulmonary resuscitation (ECPR), and that is essential to bring novel approaches to resuscitation. Their own data and experience reinforce the impression that mechanical cardiac support may benefit some patients after cardiac arrest. In addition, it is clear that ECPR, if it is deployed, should be part of optimising the entire system of emergency care. Doing system-wide optimisation will benefit the majority of patients who do not receive ECPR.

However, we would disagree with the assertion that the risk–benefit of ECPR for survival after 20 min of closed-chest cardiopulmonary resuscitation (CPR) 'approaches infinity'. The probability of good outcomes declines greatly, with CPR lasting more than 20 min, but this probability does not go completely to nil. Some patients do survive and recover with longer resuscitation...

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