Long-term neurological outcomes after extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a 14-year single-centre cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Extracorporeal Cardiopulmonary Resuscitation (ECPR) via Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO) is a viable treatment for refractory cardiac arrest (r-CA). Data on long-term outcomes and predictors of favourable neurological prognosis remain limited, and definitive patient-selection recommendations are lacking. METHODS: We conducted a retrospective observational study of adult patients treated with ECPR for in-hospital (IHCA) and out-of-hospital (OHCA) r-CA at an Italian ECMO centre between 2011 and 2024. The primary outcome was long-term neurological performance, measured by the Cerebral Performance Category (CPC) scale six months after hospital discharge. Multivariable and latent class analyses assessed independent predictors and explored distinct pre-ECPR phenotypes. RESULTS: Among 295 consecutive patients (117 IHCA; 178 OHCA), 17.3% achieved CPC 1-2 at six months (28.2% IHCA vs 10.1% OHCA; p < 0.0001), and 4.4% survived with severe long-term neurological sequelae (CPC 3-4). Independent predictors of CPC 1-2 were younger age (OR 0.95 per year, 95% CI 0.92-0.98), an initial shockable rhythm (aOR 2.7; 95% CI 1.11-7.04), and shorter low-flow duration (OR 0.95 per minute increase, 95% CI 0.93-0.97). Stepwise selection based on these criteria progressively increased the proportion of favourable survivors but excluded a small proportion who might have recovered. CONCLUSIONS: 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.
Source: Resuscitation
Authors: Matteo Pozzi, Matteo Sola, Elena Maggioni, Barbara Cortinovis, Gianluigi Redaelli, Margherita Scanziani, Alice Annoni, Elisa Del Frate, Cristina Costa, Giovanni Marchetto, Fabio Sangalli, Leonello Avalli, Marco Giani, Giuseppe Foti, Diana Aliverti Piuri, Valeria Bellin, Simone Beretta, Paolo Calzavacca, Tiziana Camisa, Salvatore Capalbi, Gianmarco Carenini, Danilo Cavenaghi, Giuseppe Colonna, Antonello Di Labio, Francesco Gaiani, Lucia Galbiati, Lucia Gandini, Stefano Gatti, Gianluca Greco, Ilaria Mariani, Valeria Meroni, Marco Normanno, Lorenzo Pomati, Francesca Rabboni, Marta Repishti, Emanuele Rezoagli, Stefano Righetti, Claudio Ripa, Simone Sosio, Pietro Vandoni, Simone Vergani, Federica Viganò
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,490
OpenAlex ID: W7154625523