Wolf Creek XVIII Part 4: innovations in ECPR technology.

The 50th Anniversary Wolf Creek XVIII Conference was hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19-21, 2025. "Innovations in ECPR Technology" was one topic of focused presentation and discussion by invited panelists and conference participants made up of international academic and industry scientists as well as thought leaders in the field of cardiac arrest resuscitation. This panel was part of the conference agenda in order to update the auditorium on the current state of the art of ECPR increasingly offered by specialized centers worldwide but still far away from routine use. In view of the ongoing high mortality and morbidity of patients treated with CPR following cardiac arrest, ECPR arises as a potential promise to improve this challenge, however many questions with respect to patient selection, implementation and the required related technical and educational resources are currently not solved and remain as relevant barriers. Moreover, current ECPR does not follow standardized protocols and is therefore a highly individualized therapy of each performing center. This is a relevant barrier in order to conduct trials with larger and more homogenous groups of patients. Despite the tempting option to overcome the shortcomings of CPR, the field of ECPR primarily requires targeted research with focus on community studies and the rationale implementation of extracorporeal circulation in the CPR scenario.