Table 3.

Common complications of prehospital ECPR

Complication	Specific Pre-hospital Concerns
Vascular injury and Bleeding	Availability of pre-hospital blood products, difficulty recognising complications such as retroperitoneal bleeding. No access to interventional radiology or operating theatres.
Failure to cannulate	Hospital-based percutaneous VA-ECMO cannulation has a reported failure rate between 7% and 10% [52, 53] and is anticipated to be higher in the pre-hospital environment. Surgical cut down may reduce the expected failure rate in the pre-hospital setting.
Limb Ischaemia	In-hospital limb ischaemia after insertion of VA-ECMO cannulae is reported in the range of 12–15% [31, 52] and would be similar in the pre-hospital environment. The usual practice of inserting a retrograde distal limb perfusion cannula would be deferred until arrival at hospital. One alternative could be using smaller calibre arterial cannulae accepting either lower flows or higher pressures.
Infection	Although the true infection rate related to ECMO cannulae insertion is unknown, ECMO is an independent risk factor of blood stream infection. [54] Pre-hospital ECMO insertion will not be as clean as an operating theatre and the infection risk may be increased.

ECPR extracorporeal cardiopulmonary resuscitation, VA-ECMO veno-arterial extracorporeal membranous oxygenation, ECMO extracorporeal membranous oxygenation