The first year of the ECMO on-site program has taught us a great deal — not only about technique, but about organisation, communication, and how complex systems fail and hold.
The time problem
In eCPR, every minute matters differently than in conventional resuscitation. It’s not about optimising compressions: it’s about reaching cannulation before anoxic damage becomes irreversible. This changes everything — logistics, patient selection, how we communicate in the field.
Selection: less is more
One of the most common mistakes in emerging programs is broadening criteria too early. The literature is clear: best outcomes occur in younger patients, shockable rhythms, witnessed arrest, and limited low-flow time. Deviating from these criteria to “not lose a patient” often means losing them anyway — but with greater invasiveness.
What the literature lacks
Most eCPR studies come from in-hospital settings with dedicated teams and short response times. The pre-hospital context is different: environmental variables, non-homogeneous teams, harder communications. The data we generate in the field matters — and we need to collect it rigorously.
To be continued.