Extracorporeal Cardiopulmonary Resuscitation in India: Current Feasibility, Challenges, and Roadmap for Implementation

Background: Extracorporeal cardiopulmonary resuscitation (ECPR), which combines extracorporeal membrane oxygenation (ECMO) with conventional cardiopulmonary resuscitation (CCPR), has emerged as a salvage therapy for refractory cardiac arrest.Global data from the Extracorporeal Life Support Organization (ELSO) report survival to discharge rates of 31-42% across age-groups, with selected trials demonstrating neurologic benefit.In India, where the population is predominantly young, and the burden of out-of-hospital cardiac arrest (OHCA) is increasing, ECPR could be lifesaving; however, its utilization remains extremely limited because of infrastructural, financial, and systemic barriers, including a lack of trained personnel and inadequate access to necessary medical equipment.Purpose: This narrative review synthesizes global evidence on ECPR outcomes and feasibility, identifies challenges specific to the Indian healthcare system, and proposes a pragmatic roadmap for implementation.Key findings: Randomized trials, including ARREST, CHEER, and PRAGUE OHCA, demonstrate improved survival and neurological outcomes with timely ECPR initiation in refractory cardiac arrest.In contrast, multicenter studies such as INCEPTION highlight heterogeneity in outcomes and the need for mature systems of care.Private-sector hospitals in India largely confine ECPR experience to in-hospital cardiac arrest (IHCA), lacking national registries and outcome data for OHCA.Major barriers include low public awareness of cardiopulmonary resuscitation (CPR), poor bystander CPR rates, underdeveloped emergency medical services, lack of coordinated transport networks, high costs, limited ECMO-capable centers, workforce constraints, and ethical concerns regarding consent, neurological prognostication, and equity.Conclusions: While the implementation of ECPR in India is still in its early stages, patients with IHCA present an immediate opportunity for integration.National policy alignment and multidisciplinary collaboration are essential to translate global evidence into scalable and contextappropriate Indian practice.