· Main Text : In extracorporeal membrane oxygenator (ECMO) - Is the RCT the Gold Standards?

The ARREST trial

→ the efficacy of ECPR for out-of-hospital cardiac arrest (OHCA) in a highly controlled and dedicated environment

The Prague OHCA study

→ Similarly dedicated environment, outcomes of conventional cardiopulmonary resuscitation (CCPR) may exceed presumed estimations by implementing advanced logistics and ECPR effectiveness itself may become impaired if inclusion criteria are widened to non-shockable rhythms

INCEPTION trial

→ the complexity of implementing ECPR in a real-world setting even in a highly developed country and underlines that implementation of ECPR for OHCA does not necessarily lead to replication of the excellent results obtained in single centers of excellence in metropolitan areas.

**INCEPTION Trial Insights**

The INCEPTION trial highlighted the challenges of implementing ECPR in centers without prior experience and standardized protocols. It revealed a high level of heterogeneity and longer times to ECMO initiation compared to other trials, potentially diluting the observed benefits of ECPR.

**Complexity of ECPR**

ECPR is a complex, resource-intensive intervention requiring coordinated efforts across various healthcare professionals. Effective implementation depends on optimized logistics, rapid ECMO initiation, and post-resuscitation care practices.

**Control Group Challenges**

The control groups in these trials showed varied outcomes, with some achieving return of spontaneous circulation (ROSC) and survival despite prolonged CPR durations, complicating the assessment of ECPR's true efficacy.