Extracorporeal Cardiopulmonary Resuscitation for In- and Out-of-Hospital Cardiac Arrest: Patient Characteristics and Survival

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Cardiac arrests can be categorized depending on location: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, studies comparing the two are scarce, especially in comparing outcomes after eCPR. This study aimed to compare patient characteristics, cardiac arrest characteristics, and outcomes.

Method: From 2016 until 2020, a total of 157 patients who underwent eCPR for cardiac arrest at our institution were divided into two groups: eCPR after IHCA (n = 66) and eCPR for OHCA (n = 91) and retrospectively analyzed for characteristics and outcome parameters. Furthermore, we used multinomial regression analysis to show which parameters contributed to favorable neurological outcomes and survival in both groups. Survival rates were expressed by Kaplan–Meier curves.

Results: Compared with IHCA, OHCA patients were younger (53.2 ± 12.4 vs. 59.2 ±12.6 years) and predominantly males (91.1 vs. 66.7%, p ≤ 0.001). The low-flow time was significantly shorter in IHCA (41.1 ± 27.4 minutes) compared with OHCA (63.6 ± 25.1 minutes). The lower low flow time did not translate to a higher survival; in-hospital mortality was not significantly different in both groups (IHCA = 72.7% vs. OHCA = 76.9%, p = 0.31). In both groups, after using multinomial regression, factors contributing to favorable neurological survival were CPR-duration, low flow time, and preimplantation lactate values.

Conclusion: ECPR increases survival and favorable neurological outcomes in patients after cardiac arrest, irrespective of the arrest´s location (IHCA or OHCA). Patients after OHCA may tolerate prolonged low flow times, presumably due to being comparably healthier.

Publication History

Article published online:
28 January 2023