Outcomes and Implications of Patients Included vs. Excluded for Extracorporeal Cardiopulmonary Resuscitation After Initial Activation

Authors

Kevin George
Joshua B. Wiener, Thomas Jefferson University
Michael Zacharias
Frank Forde
Yasir Abu-Omar
Colin McCloskey

Document Type

Article

Publication Date

1-1-2026

Comments

This article is the author’s final published version in Resuscitation Plus, Volume 27, 2026, Article number 101165.

The published version is available at https://doi.org/10.1016/j.resplu.2025.101165. Copyright © 2025 The Authors.

Abstract

BACKGROUND: The aim of this study is to describe the implementation of a new Extracorporeal Cardiopulmonary Resuscitation (ECPR) program in Cleveland, Ohio, USA. We also provide a novel comparison of outcomes between patients cannulated vs excluded from cannulation for ECPR after initial field activation.

METHODS: A prospective observational study of ECPR activations between September 2021 and February 2025. Patients meeting initial eligibility criteria for out-of-hospital cardiac arrest (OHCA)-namely based on age, bystander-CPR, and initial shockable rhythm-were transported to the emergency department where the ECPR team completed cannulation based on further biochemical criteria. Medical records were used to collect data after every ECPR activation.

RESULTS: 45 ECPR activations were identified. Among these, 13 patients were cannulated for ECMO, while 32 patients did not meet cannulation criteria. Among those cannulated, 10 of 13 (76.9 %) survived to hospital discharge vs 5 of 32 (15.6 %) who did not receive ECMO (p < 0.001). Among patients who underwent ECPR, there was no incidence of brain death or significant access site bleeding complications. The most common reason for aborted cannulation was due to the biochemical exclusion criteria of pH < 7 or lactate >15 mmol/L.

CONCLUSION: The implementation of ECPR with strict eligibility criteria resulted in a small number of cannulations but a high survival rate. Strict criteria may lead to missed opportunities for successful ECPR and occasionally trigger activation of the ECPR team without ultimately performing cannulation. As institutions develop their ECPR programs, they should carefully consider eligibility criteria in order to balance survival rate and case volume.

Recommended Citation

George, Kevin; Wiener, Joshua B.; Zacharias, Michael; Forde, Frank; Abu-Omar, Yasir; and McCloskey, Colin, "Outcomes and Implications of Patients Included vs. Excluded for Extracorporeal Cardiopulmonary Resuscitation After Initial Activation" (2026). Division of Cardiology Faculty Papers. Paper 188.
https://jdc.jefferson.edu/cardiologyfp/188

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Language

English

PubMed ID

41437943