Cardiac arrest & resuscitation
Impact of a clinical decision protocol on survival and neurological outcome following extracorporeal cardiopulmonary resuscitation
Authors' conclusion
Implementing a clinical ECPR protocol in our institutional practice improved meaningful survival in patients with refractory IHCA and OHCA fulfilling four predefined criteria including an age < 70 years, a shockable rhythm, a no-flow < 5 min, and a low-flow < 80 min.
Study context
- Population
- Adults receiving extracorporeal cardiopulmonary resuscitation (ECPR) for refractory in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at a tertiary 35-bed ICU, 2010–2024
- Participants
- 166 adults · 80 IHCAs · 86 OHCAs
- Exposure
- ECPR protocol period vs physician discretion
- Period 1n = 45reference
- Period 2n = 121
- Outcome
- Hospital mortality
Methodological detailsbefore-after (protocol implementation), single-centre
- Before-after (protocol implementation)
- Single-centre
Main finding
As reported in the abstract
Hospital survival
P = 0.015
Observational data: associations, not effects.
Secondary outcomes
Good neurological outcome (CPC 1 or 2) · 3 months
P = 0.157
Patients fulfilling all 4 criteria
P = 0.027
Death, simultaneous presence of 4 criteria (multivariable analysis)
| OR (95% CI) | P value | ||
|---|---|---|---|
| 4 criteria | 0.11 (0.01–0.87) | P = 0.037 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | P value |
|---|---|
| Survival, 4 criteria vs < 4 criteria (whole study period) | P < 0.001 |
| Good neurological outcome, 4 criteria vs < 4 criteria (whole study period) | P < 0.001 |
- Survival, 4 criteria vs < 4 criteria (whole study period): 4 criteria 48.0 %
- Survival, 4 criteria vs < 4 criteria (whole study period): < 4 criteria 9.6%
- Good neurological outcome, 4 criteria vs < 4 criteria (whole study period): 4 criteria 30.0 %
- Good neurological outcome, 4 criteria vs < 4 criteria (whole study period): < 4 criteria 5.2%
Death, simultaneous presence of 4 criteria (multivariable analysis)
- No single criterion alone significantly predictive
Original publication
Impact of a clinical decision protocol on survival and neurological outcome following extracorporeal cardiopulmonary resuscitation. J Intensive Care. Published 16 March 2026. doi:10.
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