• Martje M Suverein, DelnoijThijs S RTSRFrom the Departments of Intensive Care (M.M.S., T.S.R.D., M.E.B., M.C.G.P.), Cardiothoracic Surgery (R.L., P.W.W., J.G.M.), and Clinical Epidemiology and Medical Technical Assessment (B.E.), Maastricht University Medical Center, and the, Roberto Lorusso, George J Brandon Bravo Bruinsma, Luuk Otterspoor, Carlos V Elzo Kraemer, VlaarAlexander P JAPJ0000-0002-3453-7186From the Departments of Intensive Care (M.M.S., T.S.R.D., M.E.B., M.C.G.P.), Cardiothoracic Surgery (R.L., P.W.W., J.G.M.), and Clinical Epidemiology and Medical Technical Assessment (B.E.), Maastricht University Me, Joris J van der Heijden, Erik Scholten, Corstiaan den Uil, Tim Jansen, Bas van den Bogaard, Marijn Kuijpers, Ka Yan Lam, José M Montero Cabezas, DriessenAntoine H GAHGFrom the Departments of Intensive Care (M.M.S., T.S.R.D., M.E.B., M.C.G.P.), Cardiothoracic Surgery (R.L., P.W.W., J.G.M.), and Clinical Epidemiology and Medical Technical Assessment (B.E.), Maastricht University Medical Center, and , Saskia Z H Rittersma, Bram G Heijnen, Dinis Dos Reis Miranda, Gabe Bleeker, Jesse de Metz, Renicus S Hermanides, Jorge Lopez Matta, Susanne Eberl, Dirk W Donker, Robert J van Thiel, Sakir Akin, Oene van Meer, José Henriques, Karen C Bokhoven, Loes Mandigers, BungeJeroen J HJJHFrom the Departments of Intensive Care (M.M.S., T.S.R.D., M.E.B., M.C.G.P.), Cardiothoracic Surgery (R.L., P.W.W., J.G.M.), and Clinical Epidemiology and Medical Technical Assessment (B.E.), Maastricht University Medical Center, and the , Martine E Bol, Bjorn Winkens, Brigitte Essers, Patrick W Weerwind, Jos G Maessen, and van de PollMarcel C GMCG0000-0002-3302-4063From the Departments of Intensive Care (M.M.S., T.S.R.D., M.E.B., M.C.G.P.), Cardiothoracic Surgery (R.L., P.W.W., J.G.M.), and Clinical Epidemiology and Medical Technical Assessment (B.E.), Maastricht University.
• From the Departments of Intensive Care (M.M.S., T.S.R.D., M.E.B., M.C.G.P.), Cardiothoracic Surgery (R.L., P.W.W., J.G.M.), and Clinical Epidemiology and Medical Technical Assessment (B.E.), Maastricht University Medical Center, and the Department of Methodology and Statistics and the Care and Public Health Research Institute (B.W.), the Cardiovascular Research Institute Maastricht (R.L., J.G.M.), and the School for Nutrition and Translational Research in Metabolism (M.C.G.P.), Maastricht University, Maastricht, the Departments of Cardiothoracic Surgery (G.J.B.B.B.), Intensive Care (M.K.), and Cardiology (R.S.H.), Isala Clinics, Zwolle, the Departments of Intensive Care (L.O.) and Cardiothoracic Surgery (K.Y.L.), Catharina Hospital, Eindhoven, the Departments of Intensive Care (C.V.E.K., J.L.M.), Cardiology (J.M.M.C.), and Emergency Medicine (O.M.), Leiden University Medical Center, Leiden, the Departments of Intensive Care (A.P.J.V.), Cardiothoracic Surgery (A.H.G.D.), Anesthesia (S.E.), and Cardiology (J.H.), Amsterdam University Medical Center, and the Department of Intensive Care, Onze Lieve Vrouwe Gasthuis (B.B., J.M.), Amsterdam, the Departments of Intensive Care (J.J.H., D.W.D.) and Cardiology (S.Z.H.R.), University Medical Center Utrecht, Utrecht, the Department of Intensive Care, St. Antonius Hospital, Nieuwegein (E.S., B.G.H.), the Department of Intensive Care, Erasmus Medical Center (C.U., D.D.R.M., R.J.T., K.C.B., L.M., J.J.H.B.), and the Department of Cardiology, Thorax Center, Erasmus University Medical Center (J.J.H.B.), Rotterdam, the Departments of Intensive Care (T.J., S.A.) and Cardiology (G.B.), Haga Hospital, the Hague, and Cardiovascular and Respiratory Physiology Group, TechMed Center, University of Twente, Enschede (D.W.D.) - all in the Netherlands.
• N. Engl. J. Med. 2023 Jan 26; 388 (4): 299309299-309.

BackgroundExtracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest is inconclusive.MethodsIn this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis.ResultsOf the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of serious adverse events per patient was similar in the two groups.ConclusionsIn patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome. (Funded by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.).Copyright © 2023 Massachusetts Medical Society.

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