Prehospital extracorporeal cardiopulmonary resuscitation: global trends and the Turkish perspective

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced intervention used in refractory cardiac arrest to maintain circulation and prevent neurological injury. By diverting blood through an external oxygenator and returning it to the arterial system, ECPR provides higher cardiac output and organ perfusion than conventional CPR, thereby reducing the risks associated with prolonged low-flow states. Recent research has increasingly focused on the feasibility of initiating ECPR in prehospital environments—such as ambulances or mobile intensive care units—to minimize time to cannulation and improve survival with favorable neurological outcomes. International studies suggest that, when applied to appropriately selected patients, prehospital ECPR can reduce low-flow duration and enhance both survival and neurological recovery. However, high costs, specialized training requirements, and operational challenges currently limit its implementation to select systems with established protocols. While in-hospital ECMO use has been reported in Turkey, no published data exist regarding prehospital ECPR applications. This review examines the effectiveness, feasibility, and operational challenges of prehospital ECPR based on current literature and case experiences, and evaluates its potential within the Turkish healthcare system. Based on the reviewed literature and contextual analysis, a centralized Hub-and-Spoke model supported by a Targeted-Dispatch approach may represent a feasible strategy for resource-limited settings such as Turkey, prioritizing refractory VF/VT patients and aiming for cannulation within the critical 60-minute low-flow window. Although promising for the future of advanced prehospital resuscitation, ECPR requires meticulous planning, robust training programs, and strong interprofessional coordination. This review proposes an evidence-based Implementation Science framework tailored to national conditions to support structured and sustainable integration of ECPR into Turkish Emergency Medical Services.