13/09/2026
Three hours of CPR. Then the patient walked out of the hospital with their brain intact.
That one was a hypothermic arrest. But Jon Marinaro, a critical care physician who runs one of these programs, has put people on the machine an hour and 16 minutes into a cardiac arrest and watched them survive. "That's not some random story. At these centers that do this, this is a common thing."
Right now about 8.5 percent of people who have a cardiac arrest outside a hospital survive with their brain intact. The other 91.5 percent die, or are so neurologically devastated that they die. From 1956 until about 2000, pushing on the chest was the only thing anyone in the world could do about that. Then defibrillators went into airports, and for the people who got shocked early, survival climbed to as high as 35 to 40 percent.
Everyone else got CPR, got shocked, didn't respond, and died. Marinaro's stated career goal is to make what comes next available to the masses.
What comes next is ECMO, the same idea as cardiac bypass, done through two large cannulas in the groin, usually in an emergency department or an ICU. In Paris they do it on the floor of the Metro. Blood drains out through the venous side, a pump pressurizes it, an oxygenator adds oxygen, and it goes back in through the femoral artery, so the organs stay perfused while the heart is stopped. Centers using it during CPR are seeing around 30 percent neurologically intact survival in people who already failed the defibrillator. The reason it works is a fact most people never hear. In Marinaro's words: "75 to 78 percent of all cardiac arrests die because their brain doesn't get saved. It's not because their heart doesn't come back." The first 5 to 10 minutes are about saving the heart. After two or three shocks with no response, the question changes to how do we save the brain, and for the people who don't respond to the shocks, he says, the mortality drops off substantially.
Which brings up the one part of this anyone can do. When someone suddenly collapses and looks like they're seizing, or is still gasping, that is often what a cardiac arrest looks like, and bystanders stand around for 5 minutes trying to figure it out. If nobody has been on the chest for more than 5 minutes, that person is no longer a candidate for any of this. Start CPR. Call 911. There's a total of an hour from the collapse to getting them on the machine, and 55 minutes of it has to be good CPR.
Availability is growing, but it's still mostly major academic centers. The pumps are expensive and complicated, and the disposables alone run $14,000 to $15,000. For the first couple of years Marinaro's team ran this out of an ambulance, the pump in the back had no power at all. A firefighter hand-cranked it. "It works perfectly." Sixty years ago, he figures, only an anesthesiologist intubated a person. Now paramedics do.
Marinaro put the cost of waiting this way:
"There are just going to be a lot of body bags that do not need to be filled."
Listen to the full conversation on The Podcast by KevinMD. Link in the comments.
