Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.

院内和院外心脏骤停的功能恢复生存率都非常低。体外心肺复苏 (ECPR) 正在成为一种改善预后的方式，它通过在常规 CPR 期间利用体外膜氧合 (ECMO) 来增加对重要终末器官的灌注，并使患者稳定下来以进行旨在逆转心脏骤停病因的干预措施。实施这一紧急程序需要大量资源投资，即使是最成功的 ECPR 计划也可能会给医疗保健系统、临床医生、患者及其家人带来负担，因为无法挽救的患者需要借助体外设备。非随机和观察性研究一再表明，与传统心肺复苏术相比，ECPR 与提高生存率之间存在关联，用于特定患者群体的院内心脏骤停。最近，随机对照试验表明 ECPR 优于标准复苏，以及在高度协调的医疗服务系统中对院外心脏骤停进行此类试验的可行性。应谨慎地将这些数据应用于临床实践，结果可能因启动 ECPR 的环境和系统而异。ECPR 引入了重要的伦理挑战，包括它是否应该被视为 CPR 的延伸，在什么时候它成为持续的器官替代疗法，以及如何处理无法康复或过渡到心脏替代疗法的患者。ECPR 的经济影响因卫生系统而异，如果不加区别地使用，可能会耗尽资源。理想情况下，