Timing and Mode of Death Following ECPR: A Single Centre, Retrospective Analysis.

Background: Currently little is known about the timing and modality in which people die following extracorporeal cardiopulmonary resuscitation (ECPR). This is important as it may define potential therapeutic targets, pathways for improvement in ECPR outcomes, and resource implications. Therefore, we undertook a study to analyse the mechanisms and timeframes of death within the first 28 days in a high-volume Australian ECPR centre.

Method: This was a single-centre, retrospective review from 1 January 2017 until 31 December 2022. All patients undergoing ECPR were analysed. Modality of death was classified into neurological (subclassified as brain death or withdrawal of life-sustaining treatment [WLST] without brain death) or non-neurological (subclassified as refractory shock or non-neurological WLST).

Results: A total of 95 patients were included. Overall, 52/95 (54.7%) had an out-of-hospital cardiac arrest. In total, 51/95 (53.7 %) had died by day 28. The most common modality of death was neurological WLST without brain death. The earliest modality of death to occur was refractory shock. Median survival times were 0 days (interquartile range [IQR] 0-2) for patients with refractory shock, 2 days (IQR 1-4) for brain death, 3 days (IQR 1-8) for non-neurological WLST and 9 days (IQR 2-14) for neurological WLST without brain death. Four (7.8%) patients underwent organ donation.

Conclusions: Mortality post ECPR remains high. Refractory shock is the earliest modality of death while neurological WLST without brain death is most common, occurring several days later. Understanding the different phenotypes of death post-ECPR is important to identify future potential therapeutic targets.