What stood out to me: > After enrolling just 30 patients, the ARREST trial was stopped early by an N.I.H. board because the patients who got ECPR did so much b

What stood out to me: > After enrolling just 30 patients, the ARREST trial was stopped early by an N.I.H. board because the patients who got ECPR did so much better than the control-group subjects who received standard resuscitation, and it would have been unethical to continue the study. After six months, 43 percent of the 14 patients who got ECPR were alive with good brain function, compared with zero in the control group. > Yannopoulos has invited physicians from all over to visit his program; afterward, he often hears from them that replicating his work at their home institutions — getting health and E.M.S. systems to collaborate, finding institutional support and start-up funding, coordinating 24/7 staffing — seems too daunting. For these reasons, Yannopoulos regards his ECPR program as “an administrative and political achievement, rather than a scientific or technological one.” > Experience matters profoundly: According to a 2022 paper based on data from the Extracorporeal Life Support Organization, an international nonprofit that Robert Bartlett founded, patients treated at centers that perform fewer than 10 ECPR procedures yearly have 64 percent lower odds of survival; for every 10-case increase, the odds go up 11 percent. (The Minnesota program treats about 150 every year.) In my 20+ years working in public policy analysis and advocacy, cannot agree more with #2, that administrative and political environment matter. Thinking about Atul Gawande's checklist, this is certainly the case. Having people and institutions prepared to adopt different behavior is essential. Of course, I was working in an often lower stakes environment and part of my work was to determine what institutional and personnel changes needed to be made to have our policy changes be effective. Frequently, people liked the idea of the policy change but were not prepared to do the hard work of the environmental changes.