Cardiology · Internal Medicine · 2 h ago
On-scene ECPR linked to better outcomes after refractory cardiac arrest
A prospective registry study of 1,031 patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) in the Greater Paris area found higher rates of favourable neurological outcome with on-scene than hospital-based ECPR. The observational findings may reflect differences in patient selection and require confirmation in randomized trials.
- Favourable neurological outcome was 13% with on-scene ECPR.
- Hospital-based ECPR group had a 6% favourable outcome rate.
- ECPR initiation was 23 minutes earlier on scene.
- Observational findings need confirmation in randomized trials.
Researchers analysed a multicentre prospective registry of out-of-hospital cardiac arrests in the Greater Paris area from May 2011 to August 2024. Among 52,505 recorded arrests, 1,031 patients received ECPR; 256 were treated on scene and 775 after hospital arrival. The primary outcome was survival to hospital discharge with favourable neurological status, defined as Cerebral Performance Category 1 or 2.
Favourable neurological outcome occurred in 13% of patients receiving on-scene ECPR and 6% receiving hospital-based ECPR (P<0.01). Median time from CPR to ECPR initiation was 70 versus 93 minutes, respectively. After adjustment, on-scene ECPR was associated with higher odds of favourable outcome (OR 2.3, 95% CI 1.4–3.9); propensity score-matched analysis showed a similar association (OR 2.1, 95% CI 1.1–4.1). On-scene ECPR was also associated with overall survival at one year.
These findings support further evaluation of on-scene ECPR for carefully selected patients with refractory cardiac arrest, but do not establish that the strategy causes better outcomes. The registry was observational and drawn from one region; the authors call for randomized trials and studies in other healthcare systems, including evaluation of long-term neurological recovery and system-level effects.
In practice
For clinicians involved in systems of care for refractory out-of-hospital cardiac arrest, this registry suggests that an on-scene ECPR strategy may be associated with better neurological outcomes and faster ECPR initiation than hospital-based ECPR in selected patients. It does not show that on-scene treatment causes the difference or identify which patients benefit most. The evidence is observational and from the Greater Paris area; it is not sufficient to establish a general practice change. Randomized trials and evaluation in other healthcare systems are needed.
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Critical Care: Extracorporeal cardiopulmonary resuscitation strategies for refractory out-of-hospital cardiac arrest ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.