The effect of restrictive vs liberal selection criteria on survival in ECPR: A retrospective analysis of a multi-regional dataset.

Abstract

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is an established rescue therapy for both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, there remains significant heterogeneity in populations and outcomes across different studies. The primary aim of this study was to assess the effect of applying different selection criteria on survival and utilisation in an Australian ECPR cohort. Methods We performed a retrospective, observational study of three established ECPR centres in Australia, including cases from 1 January 2013 to 31 December 2020 to establish the baseline cohort. We applied five commonly used ECPR selection criteria, ranging from restrictive to liberal. Results The baseline cohort included 199 ECPR cases: 95 OHCA and 104 IHCA patients. Survival to hospital discharge was 20% for OHCA and 41.4% for IHCA. For OHCA patients, strictly applying the most restrictive criteria would have resulted in the highest survival rate 7/16 (43.8%) compared to the most liberal criteria 16/73 (21.9%). However, only 16/95 (16.8%) in our cohort strictly meeting criteria with restrictive criteria versus 73/95 (76.8%) with liberal. Similarly, in IHCA, more restrictive criteria would have resulted in a higher survival rate in eligible patients 10/15 (66.7%) vs 27/59 (45.8%) compared to more liberal criteria; 33/43 (77%) and 16/43 (37%) of survivors, respectively, would not have been eligible for ECMO if strictly applying these selection criteria. Conclusions Adherence to different selection criteria impacts both the ECPR survival rate and the total number of survivors. Commonly used selection criteria may be unsuitable to select ICHA ECPR patients.