Outcomes and implications of patients included vs excluded for extracorporeal cardiopulmonary resuscitation after initial activation.

BACKGROUND

The aim of this study is to describe the implementation of a new Extracorporeal Cardiopulmonary Resuscitation (ECPR) program in Cleveland, Ohio, USA. We also provide a novel comparison of outcomes between patients cannulated vs excluded from cannulation for ECPR after initial field activation.

METHODS

A prospective observational study of ECPR activations between September 2021 and February 2025. Patients meeting initial eligibility criteria for out-of-hospital cardiac arrest (OHCA)-namely based on age, bystander-CPR, and initial shockable rhythm-were transported to the emergency department where the ECPR team completed cannulation based on further biochemical criteria. Medical records were used to collect data after every ECPR activation.

RESULTS

45 ECPR activations were identified. Among these, 13 patients were cannulated for ECMO, while 32 patients did not meet cannulation criteria. Among those cannulated, 10 of 13 (76.9 %) survived to hospital discharge vs 5 of 32 (15.6 %) who did not receive ECMO (p < 0.001). Among patients who underwent ECPR, there was no incidence of brain death or significant access site bleeding complications. The most common reason for aborted cannulation was due to the biochemical exclusion criteria of pH <7 or lactate >15 mmol/L.

CONCLUSION

The implementation of ECPR with strict eligibility criteria resulted in a small number of cannulations but a high survival rate. Strict criteria may lead to missed opportunities for successful ECPR and occasionally trigger activation of the ECPR team without ultimately performing cannulation. As institutions develop their ECPR programs, they should carefully consider eligibility criteria in order to balance survival rate and case volume.