Implementation of a regional extracorporeal membrane oxygenation program for out-of-hospital cardiac arrest: results of the prospective observational study.
Resuscitation plus · 2025-11-24 · Observational study
Abstract
BACKGROUND: We implemented a multi-centre extracorporeal cardiopulmonary resuscitation (eCPR) program in a regional emergency medical services (EMS) system and assessed the time-to-cannulation, survival, and neurologic outcomes for patients routed by EMS to eCPR-capable centres. METHODS: This was an observational study of patients with out-of-hospital cardiac arrest (OHCA) transported to eCPR-capable centres from July 2020 to September 2024. Patients were routed to an eCPR-capable centre if all applied: age 15-75, refractory/recurrent shockable arrest, a mechanical compression device (MCD) applied, and treatment by a participating EMS unit. Additional patients were routed on clinician judgment. Patients with traumatic arrest, do-not-resuscitate order, known terminal illness, baseline severe neurologic deficit, pregnancy, MCD contraindications, or estimated >30-min transport to an eCPR-capable centre were not routed. The outcomes were survival to hospital discharge (SHD) and neurologic status at discharge. We conducted a logistic regression with inverse-probability weighting to evaluate the association between eCPR and patient outcomes. RESULTS: There were 233 patients routed for eCPR. Median age was 58 years (IQR 48-65), 51 (22 %) were female. Fifty-eight (27 %) were cannulated for eCPR; median time from arrest to cannulation was 66 min (IQR 58-78). Both for all routed patients and among those cannulated, SHD was 27 % and SHD with cerebral performance category (CPC) 1 or 2 was 21 %. In the regression analysis, eCPR was not associated with improved outcomes. CONCLUSION: In this regional eCPR program, survival among patients refractory to conventional therapy and treated with eCPR was 27%.