Impact of extended eligibility criteria on survival after veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: a 8-year single-center study

Aim

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may improve survival in refractory in- or out-of-hospital cardiac arrest (IHCA/OHCA), yet optimal selection criteria remain uncertain. We aimed to report contemporary survival rates after VA-ECMO for cardiac arrest (E-CPR) and to explore prognostic significance of extended criteria in improving patient selection.

Methods

We conducted an observational single-center study of patients treated with E-CPR from 2017 to 2024. Patients were stratified according to four extended inclusion criteria in favor of E-CPR (arterial pH > 6.8, lactate < 15  mmol/L, low-flow time < 100  min, signs of life during CPR). Primary outcome was 180-day survival.

Results

Of 159 patients included, 59 (37 %) were alive at 180 days, and 82 % of survivors had favorable neurological outcomes. Transient ROSC (OR 0.25, 95 % CI 0.13–0.49) and signs of life during CPR (OR 0.37, 95 % CI 0.19–0.75) were associated with lower mortality in univariate analysis. In multivariate analysis, only age (OR 1.03, 95 % CI 1.00–1.06) and transient ROSC (OR 0.25, 95 % CI 0.11–0.56) remained independently associated with 180-day mortality. Kaplan-Meier survival analysis showed significant differences between groups (log-rank p < 0.05), with survival ranging from 21 % in patients meeting none or one criterion in favor of E-CPR to 56 % in those meeting all four.

Conclusion

In this single-center cohort, we observed a 180-day survival rate of 38 % among patients treated with E-CPR for refractory cardiac arrest. Notably, our study suggests acceptable survival rates of 21 % even in patients with an adverse risk profile.