To the Editor I have several concerns about the recently published HYPO-ECMO trial. First, I wonder whether this trial’s exclusion of 72 patients who underwent cardiopulmonary resuscitation (CPR) for more than 45 minutes before initiation of ECMO was appropriate. In a previous trial comparing extracorporeal CPR with conventional treatment for patients with refractory ventricular fibrillation and out-of-hospital cardiac arrest, the average time from 911 call to initiation of ECMO in the extracorporeal CPR group was 59 minutes, and the rate of survival to discharge was 43% in the extracorporeal CPR group.
