This is a single Center interventional study, assessing the feasibility of a complex treatment strategy where an in-hospital standard care process is applied in an out-of-hospital cardiac arrest.

The objective of this study is to investigate the feasibility of a prehospital eCPR program in the context of the Pavia province in order to reduce the time from cardiac arrest to organ reperfusion with thefarthest aim of improving survival and good neurologic outcomes of patient victims of refractory cardiac arrest.

Inclusion Criteria:

• out-of-hospital cardiac arrest occurred in Pavia province
• the age of the patient is between 18 and 70
• witnessed cardiac arrest
• CPR started within 5 minutes of the patient's collapse or presence of gasping at the arrival of the ACLS team
• eCPR team arrived within 60 minutes of the patient's collapse
• etCO2 ≥ 10 mmHg
• mechanical chest compression is ongoing
• refractory cardiac arrest after at least 15 minutes of ACLS

Exclusion Criteria:

• Modified Rankin Scale (mRS) ≥ 3
• Advanced COPD or other advanced pulmonary illness
• End-stage or metastatic neoplasm