Hyperinvasive Approach in Cardiac Arrest

Inclusion Criteria: * minimum of 18 and maximum of 65 years * witnessed out-of-hospital cardiac arrest of presumed cardiac cause * minimum of 5 minutes of ACLS performed by emergency medical service team without sustained ROSC * unconsciousness (Glasgow Coma Score \< 8) * ECMO team and bed-capacity in cardiac center available. Exclusion Criteria: * OHCA of presumed non-cardiac cause * unwitnessed collapse * pregnancy * sustained ROSC within 5 minutes of ACLS performed by EMS team * conscious patient * known bleeding diathesis or suspected or confirmed acute or recent intracranial bleeding * suspected or confirmed acute stroke * known severe chronic organ dysfunction or other limitations in therapy * "do not resuscitate" order or other circumstances making 180 day survival unlikely * known pre-arrest cerebral performance category CPC ≥ 3.