Extracorporeal life support for cardiac arrest due to pulmonary embolism: further studies are needed

Until recently, cardiopulmonary resuscitation (CPR) has represented the only method to support life in cardiac arrest. During CPR, artificial circulation is produced by chest compression while pulmonary function is supported by positive pressure ventilation. Basic CPR techniques can be taught to everyone and used by everyone, which has enabled thousands of lives to be saved worldwide. The main scope of CPR is to sustain life until the reversible causes of cardiac arrest are treated. Unfortunately, definitive treatments may take time to be implemented and have effect, while effective CPR can rarely be maintained for more than 20–30 min. Many factors, as rescuers’ fatigue, metabolic acidosis and ‘stone heart’ phenomenon1 compromise the effectiveness of CPR during prolonged resuscitation. Extracorporeal life support (ECLS) represents an innovative technique for the treatment of cardiac arrest, especially when standard measures are ineffective. ECLS consists of a percutaneous venoarterial cardiopulmonary bypass connected to an extracorporeal membrane oxygenator coupled with a cardiac pump. This system maintains an oxygenated blood flow to vital organs even in the complete absence of cardiac contraction witnessed cardiac arrest caused by pulmonary thromboembolism, ECLS is an interesting therapeutic resource which has been only minimally investigated in the medical literature. Prospective studies on large populations will be needed to confirm this potential and to evaluate how the benefits of ECLS treatment in this condition compare with those observed in primary cardiac arrest.