Cardiac arrest & resuscitation
Long-term neurological outcomes after extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a 14-year single-centre cohort study
Authors' conclusion
These results emphasise the importance of establishing pre-treatment selection criteria to optimise ECPR use and enhance long-term neurological outcomes. Age, initial rhythm, and low-flow time are key determinants, and exploratory phenotype-based analyses suggest multidimensional patient characterisation may complement traditional selection criteria.
Study context
- Population
- Adults treated with Extracorporeal Cardiopulmonary Resuscitation (ECPR) via veno-arterial Extracorporeal Membrane Oxygenation (ECMO) for refractory cardiac arrest at an Italian ECMO centre, 2011–2024
- Participants
- 295 consecutive patients
- Exposure
- IHCA vs OHCA treated with ECPR
- IHCAn = 117
- OHCAn = 178reference
- Outcome
- Long-term neurological performance (Cerebral Performance Category scale)
- Follow-up
- Six months after hospital discharge
Methodological detailssingle-centre, observational, multivariable and latent class analyses
- Single-centre
- Observational
- Multivariable and latent class analyses
Main finding
As reported in the abstract
CPC 1-2 at six months · six months
P < 0.0001
- Cerebral Performance Category (CPC) 1-2 at six months, all patients
- 17.3%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Independent predictors of CPC 1-2Age (per year) · younger age · multivariable analysis | 0.95 (0.92–0.98) | |
| Independent predictors of CPC 1-2Low-flow duration (per minute increase) · shorter low-flow duration · multivariable analysis | 0.95 (0.93–0.97) | |
| 0.512Odds ratio (log scale) |
Independent predictors of CPC 1-2
| aOR (95% CI) | ||
|---|---|---|
| Initial shockable rhythmMultivariable analysis | 2.7 (1.11–7.04) | |
| 0.10.31310Adjusted odds ratio (log scale) |
Survival with severe long-term neurological sequelae (CPC 3-4) · six months
- All patients
- 4.4%
Stepwise selection based on these criteria
- Progressively increased the proportion of favourable survivors but excluded a small proportion who might have recovered
Original publication
Long-term neurological outcomes after extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a 14-year single-centre cohort study. Resuscitation. Published 16 April 2026. doi:10.
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