Extracorporeal life support (ECLS) has shown benefits in the management of refractory inhospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P 5 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P 5 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS. Key Words: Extracorporeal life support-Cardiac arrestCardiopulmonary resuscitation.Conventional management of cardiac arrest (CA) has evolved considerably in recent years, nevertheless mortality is still high (1,2). This is essentially related to the neurological prognosis and thus to cerebral damage due to ischemia and reperfusion injury. Given this, the management of CA should focus on maintaining effective circulation during the external cardiac massage and to manage adequately the return to spontaneous circulation.The use of extracorporeal life support (ECLS) for the management of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) has been widely described (3). Nonetheless, doubts have been expressed about the usefulness of ECLS in OHCA (4). Indeed, rapid ECLS implementation is a major concern. However, in large towns with heavy traffic, timely implementation of ECLS and restoration of effective circulation is sometimes very long.To update our management practices and to determine the usefulness of ECLS in OHCA, we conducted a retrospective study of all IHCA and OHCA treated with ECLS to compare survival and the neurological prognosis of our patients.

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