P168. Survival and Neurodevelopmental Outcomes After Conventional CPR and ECPR in Children After Pediatric Cardiac Surgery

Extracorporeal cardiopulmonary resuscitation (ECPR) can restore circulation in refractory out-of-hospital cardiac arrest (OHCA). A trial-based analysis with a one-year horizon showed limited cost-effectiveness of this demanding procedure. However, arguably, long-term incremental health benefits may justify high initial incremental costs. We assessed the cost-effectiveness of ECPR compared to conventional cardiopulmonary resuscitation (CCPR) for OHCA with a lifetime horizon using trial-based data. Healthcare and societal costs and Quality Adjusted Life Years (QALY), assessed using EQ-5D-5L, were simulated over a 20-year period following ECPR or CCPR for OHCA using a Markov model. Data from the per-protocol population of a multicenter randomized controlled trial comparing ECPR with CCPR were used as input parameters. The Incremental Cost-Effectiveness Ratio (ICER) was expressed as Euros per QALY. Probabilistic and deterministic sensitivity analyses were performed. We used data from 33 ECPR and 47 CCPR patients. Mean±SD costs after one year were €26.372 ± 28.237 versus €10.356 ±37.706 and survival was 15% vs. 9% in patients treated with ECPR versus CCPR. Over a lifetime horizon, mean incremental costs and QALYs of ECPR were €160.969 and 0.66, respectively, resulting in an ICER of €242.122/QALY. At a willingness-to-pay threshold of €80.000 per QALY gained, the probability of ECPR being cost-effective was 46%. The costs of non-survivors in both arms and the QALYs gained were the major drivers of the ICER. ECPR for refractory OHCA has a low probability of being cost-effective. To enhance cost-effectiveness, improving ECPR effectiveness and reducing hospital costs of ECPR non-survivors are mandatory.

Introduction: Survival after cardiac arrest and prolonged conventional cardiopulmonary resuscitation remains poor, with out-of-hospital survival rates of only 2%-10%. Conventional veno-arterial extracorporeal membrane oxygenation or extracorporeal cardiopulmonary resuscitation can restore circulation but provides uncontrolled reperfusion, fails to prevent ischemia-reperfusion injury and offers limited physiological monitoring, resulting in inconsistent neurological outcomes. Experimental evidence indicates that tissue viability after prolonged ischemia depends not only on its duration but critically on how reperfusion is performed. Methods: Controlled reperfusion strategies, such as controlled automated reperfusion of the whole body, achieve superior preservation of neurological and multi-organ function. Building on prior single-organ reperfusion research, controlled automated reperfusion of the whole body was developed as a next-generation, portable extracorporeal membrane oxygenation-based platform for multi-organ recovery after cardiac arrest and prolonged conventional cardiopulmonary resuscitation. Results: It integrates (1) advanced extracorporeal circulation with high pressure, high flow, pulsatility and rapid hypothermia; (2) a cytoprotective regimen targeting ischemia and reperfusion injury; (3) real-time hemodynamic, metabolic and temperature monitoring; and (4) a mobile design for rapid deployment. In experimental studies, controlled automated reperfusion of the whole body achieved up to 90% survival with intact neurological function after 20 min of cardiac arrest in porcine models. First clinical applications (since 2017) demonstrated favorable outcomes even after 120 min of conventional cardiopulmonary resuscitation. A recent multicenter European study (n = 69) reported 42% overall survival, with 79% of survivors achieving favorable neurological recovery (Cerebral Performance Category 1-2) at 90 days, particularly in in-hospital cardiac arrest and pre-hospital cannulation subgroups. Conclusion: Controlled automated reperfusion of the whole body thus represents a major advance in resuscitation science, enabling controlled multi-organ recovery after prolonged whole-body ischemia.

Conventional cardiopulmonary resuscitation (CPR) is guided primarily by process metrics that do not directly quantify cerebral hemodynamics or perfusion. Near-infrared spectroscopy (NIRS) provides continuous, non-invasive monitoring of regional tissue oxygenation and has emerged as a candidate modality for physiologic feedback during low-flow states. However, CPR applications vary across devices and signal processing. This scoping review maps how NIRS has been implemented during conventional CPR in humans and porcine models, with emphasis on instrumentation characteristics, signal processing, acquisition bandwidth, artifact handling, physiologic associations, and feasibility constraints. From 1048 records, 39 studies met the inclusion criteria. Most used forehead-based cerebral rSO2 monitoring (30/39). Rising cerebral oxygenation trajectories were consistently associated with return of spontaneous circulation (ROSC). In contrast, persistently low or non-increasing patterns were associated with non-ROSC, and absolute thresholds varied substantially across devices and studies. A minority of investigations derived compression-rate or waveform features from hemoglobin signals. Feasibility findings emphasized rapid probe placement without interrupting compressions but highlighted motion artifact, workflow constraints, and incomplete acquisition reporting. Overall, during conventional CPR, NIRS primarily serves as a dynamic monitor of oxygenation trends rather than a validated prognostic tool. Emerging waveform-based and hemodynamic analyses suggest the potential to evaluate CPR efficiency using perfusion-responsive optical features.

Cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions at the lower half of the sternum. This may lead to aortic valve compression, which is associated with poor outcomes, while compressions over the left ventricle are seldom achieved. To test the hypothesis that transesophageal echocardiography (TEE) guidance during CPR to avoid aortic valve compression and target the left ventricle would improve outcomes in patients with nontraumatic out-of-hospital cardiac arrest compared with conventional CPR. This cluster-randomized clinical trial (the EXECT-CPR study) was conducted from June 26 to November 19, 2023, at 1 tertiary medical center in Taiwan. Participants were adults who consecutively presented to the emergency department (ED) with nontraumatic out-of-hospital cardiac arrest. Exclusion criteria were prehospital return of spontaneous circulation, extracorporeal CPR, contraindications to TEE, prior do-not-resuscitate orders, and obvious signs of death. Complete blinding was not feasible; the allocation schedule was disclosed only to the principal investigator. Post-ED arrival CPR at TEE-guided (avoid aortic-valve compression and target the left ventricle) or guideline-recommended (the lower half of the sternum) site. The primary outcome was a sustained return of spontaneous circulation (≥20 minutes). Secondary outcomes were any return of spontaneous circulation, survival to intensive care unit admission, survival to hospital discharge, cerebral performance category of 2 or lower at discharge, and intra-CPR end-tidal carbon dioxide levels. A total of 132 patients underwent randomization (66 in each group; median [IQR] age, 68 [55-74] years; 87 [66%] male). The primary outcome was similar between groups (TEE-guided group, 29 [44%]; conventional group, 26 [39%]; cluster-adjusted odds ratio, 1.21; 95% CI, 0.64-2.29). The secondary outcomes also did not significantly differ, except for higher intra-CPR end-tidal carbon dioxide levels in the TEE-guided group during the 11th to 20th minutes after arrival. Adverse event rates related to TEE and CPR were comparable. In this randomized clinical trial among adults transported to the emergency department with ongoing CPR for nontraumatic out-of-hospital cardiac arrest, TEE-guided CPR with an adjusted compression site after arrival did not significantly improve clinical outcomes compared with conventional CPR, although it produced potential hemodynamic benefits without increasing adverse events. Given that the trial was underpowered due to optimistic effect size assumptions, these neutral findings should be interpreted with caution. ClinicalTrials.gov Identifier: NCT05907460.

Extracorporeal Membrane Oxygenation (ECMO) is a form of mechanical circulatory support that combines an extracorporeal blood pump with an oxygenator 1. Extracorporeal Life Support (ECLS), or ECMO, has the ability to perform cardiac and pulmonary functions in case these systems failure2.These life support systems are efficient and can prove lifesaving in cases of severe cardiopulmonary depression. It can be used when conventional CPR (Cardiopulmonary resuscitation) fails to restore the spontaneous cardiopulmonary function. It gained popularity during the COVID-19 pandemic, as it was used to provide life support to critically ill patients3. The availability of ECMO is an issue in developing countries. Only a limited number of emerging these nations possess access to these sophisticated systems. ECMO is a relatively new technology for which very few individuals are trained to use it effectively. There are numerous complications associated with the use of this lifesaving equipment. Inadequate mechanical ventilator care during ECMO can result in ventilator-associated infections and delayed lung recovery. Bleeding, thrombosis, haemolysis, renal and neurological damage, concurrent infections, and mechanical and technical issues are among the short-term complications. The physical, functional, and neurological sequelae of critical illness are reflected in long-term complications4. These complications can be mitigated in ECMO-assisted patients by applying the appropriate skill and expertise. Prior to initiation, a thorough understanding of ECMO equipment handling, timing of initiation, and patient selection criteria is mandatory. ECMO patients need to be managed carefully to prevent life-threatening complications and must be kepton standby for surgical circuit exchange5.Continuous monitoring of ECMO patients is necessary to avoid any debilitating or fatalcomplication. Comprehensive ECMO training programs for physicians can significantly reduce the risk of complications by ensuring proper technique, timely intervention, and informed clinical decision-making throughout the course of ECMO support.

Development and validation of a medical latex glove-type real-time cardiopulmonary resuscitation feedback device.

Cardiogenic shock is characterized by failure of the cardiac pump, requiring early recognition and prompt hemodynamic stabilization. The SCAI-SHOCK classification, which grades severity across five stages, facilitates standardized clinical communication and ensures population homogeneity in clinical trials. In cases of cardiogenic shock refractory to medical treatment, temporary mechanical circulatory support (MCS) is essential to maintain systemic blood flow and preserve end-organ function. This monocentric retrospective study analyzes ten years of experience with temporary MCS at the University Hospital (CHU) of Liège. Data are presented according to ischemic and non-ischemic etiologies. Outcomes of temporary MCS in cardiac arrest refractory to conventional cardiopulmonary resuscitation, as well as the use of monoventricular microaxial pumps, are also evaluated. Close multidisciplinary collaboration is crucial to address reversible causes, limit the duration of low cardiac output, and improve patient prognosis. This study highlights the evolution of management strategies and the importance of integrated care in optimizing clinical outcomes.

Extracorporeal Cardiopulmonary Resuscitation in Adult Patients Following In-Hospital and Out-of-Hospital Refractory Cardiac Arrest: A Narrative Review.

BackgroundIn emergency settings, obtaining timely informed consent is not always feasible, making deferred and waived consent a potential solution. Despite its frequent use in high-risk research, the experiences and opinions of patients and (bereaved) relatives have been scarcely investigated. This study examined their attitudes towards enrolment in the INCEPTION-trial (NCT03101787) on extracorporeal cardiopulmonary resuscitation (ECPR).MethodsQuestionnaires were sent to survivors and (bereaved) relatives who had signed consent forms for follow-up research in the initial INCEPTION-trial. Additionally, relatives where consent was waived were contacted through their general practitioner with a request to participate. Responses included Likert-scale and free-text data, were analysed using descriptive statistics and non-parametric tests.ResultsA total of 32 of 38 (overall response rate 84.2%) sent questionnaires were returned, from 9 survivors, 9 corresponding relatives of these survivors, 6 relatives of non-survivors who provided proxy consent and 8 relatives of non-survivors whose consent was waived. 81.3% of the respondents (strongly) supported alternative consent procedures. No statistically significant differences were found between survivors and non-survivors or ECPR versus conventional cardiopulmonary resuscitation (CCPR). The need for, and challenges of research in an emergency setting were acknowledged. Aftercare contact improved understanding of the trial and helped in bereavement processing.ConclusionsOverall, patients and (bereaved) relatives had a positive attitude towards waived and deferred consent procedures in high-risk, high-mortality research in the emergency setting. Information provision at a later stage, once the emotional burden has eased, is appreciated.

BackgroundUltrasound-guided cardiopulmonary resuscitation (UG-CPR) offers healthcare providers real-time, sonographic guidance during CPR. Transesophageal echocardiography-guided CPR (TEE-CPR) is limited to institutions with the prerequisite equipment and expertise. Learnings from TEE-CPR have the potential to improve conventional CPR methods, particularly in identification of alternate areas of compression (AOC) when conventional compressions fail. It is unclear how often, and to what extent, performing TEE-CPR compressions varies from conventional compressions. This study explored and compared healthcare provider impressions of performing chest compressions during conventional and TEE-CPR.MethodsAn online survey was distributed to healthcare providers working at TEE-CPR sites throughout Canada. The 34-item survey explored commonalities and differences between conventional and TEE-CPR. Quantitative and qualitative analyses were used to describe changes in the AOC, compression dynamics including changes in chest wall and compression effort, and logistical differences associated with integration into broader resuscitative choreography.ResultsAmongst 30 respondents from 5 distinct sites, 96.7% reported instances of TEE-CPR where the AOC was moved away from the conventional site to improve chest compression quality. Further, 76.7% of respondents indicated altering the AOC during at least half of TEE-CPR events. Alternate areas of compression were more common than the conventional AOC after initiation of TEE-CPR (pre-ultrasound conventional 25: alternative 5 versus post-ultrasound conventional 13: alternative 17, X2 (1,N = 30)=10.3, p = 0.0013). The reported shift was predominantly leftward (61.0%), then caudal (26.2%). Providers reported improved chest compression quality from real-time visual feedback. Most providers reported similar exertional effort while performing chest compressions.ConclusionsUse of TEE-CPR often leads to adjustments in chest compression location, predominantly in a leftward and/or caudal direction. Performing TEE-CPR compressions was reported to have minimal impact on provider exertion as compared to conventional CPR. Prospective research mapping the locations and frequencies of alternate AOCs during TEE-CPR, and associated clinical outcomes, are warranted.

BackgroundAutomated head-up (AHUP) CPR, combining controlled head/thorax elevation, active compression-decompression CPR, and an impedance threshold device, has shown improved survival with favorable neurological outcomes versus conventional (C) CPR. The optimal amount of active lift (AD) during AHUP-CPR to optimize survival remains unknown. This study focused primarily on 24-h survival with 1-cm of active lift (AL-1 cm) with a rectilinear waveform versus 3-cm of active lift (AL-3 cm) with a trapezoidal waveform during AHUP-CPR.MethodsAnesthetized pigs (n = 24, ∼40 kg) were randomized to AL-1 cm or AL-3 cm after 10 min of ventricular fibrillation. CPR began with 2 min of C-CPR (21% AP depth, sinusoidal waveform, 100/min), followed by 18 min of AHUP-CPR using the assigned AL. Asynchronous ventilation (10 ml/kg, 10/min) was provided. Epinephrine and amiodarone were administered after 19 min of CPR with defibrillation 1 min later. Primary outcome: 24-h survival; Secondary outcomes: return of spontaneous circulation (ROSC), hemodynamics, epinephrine response, and neurological function (Neurological Deficit Score [NDS], 0 = normal, 320 = death). Statistical analyses included t-test, Kaplan-Meier, log-rank, and Mann-Whitney U tests.ResultsROSC occurred in 6/12 pigs with AL-1 cm vs 12/12 with AL-3 cm (p = 0.03), and 24-h survival rates were 16.7% vs 41.7%, respectively (p = 0.04). Hemodynamics, ETCO2, epinephrine response, and changes in rSO2 values were significantly higher with AL-3 cm. NDS was 286 ± 79 (AL-1 cm) vs 213 ± 130 (AL-3 cm, p = 0.09).Conclusion24-h survival rates were significantly higher with AL-3 cm vs AL-1 cm during AHUP-CPR. Together with improved hemodynamics observed with AL-3 cm, these outcomes underscore the critical importance of AL-3 cm to optimize AHUP-CPR.

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is thought to be efficient when performed promptly after cardiac arrest. However, its neurological benefit remains questionable if applied very early and systematically. Accordingly, we sought to compare systemic and cerebral hemodynamics when ECPR was implemented systematically compared to conventional cardiopulmonary resuscitation (CCPR) with epinephrine.Material and methodsFollowing 5 min of untreated ventricular fibrillation, pigs were randomly submitted to CCPR with epinephrine or crystalloid-primed ECPR after either a 10- or 30-min low-flow (4 groups: CCPR 10′, ECPR 10′, CCPR 30′ and ECPR 30′. Defibrillations were then delivered until the return of spontaneous circulation (ROSC). Swine were followed 240 min from cardiopulmonary onset.ResultsSix pigs were included in each group. Survival rate was higher in CCPR 10′ group vs ECPR 10′ (6/6 vs 2/6; p = 0.02) but not significantly different between CCPR 30′ and ECPR 30′ groups (2/6 vs 0/6; p = 0.53). In ECPR 10′ and 30′ groups, ECPR was associated with lower cerebral perfusion pressure, lower jugular venous oxygen saturation and higher-pressure reactivity index after ROSC, as compared to CCPR 10′ and 30′. A decrease in mean arterial pressure, along with an increase in norepinephrine dose and blood lactate level were also found in ECPR 10′ and 30′ groups after ROSC, as compared to CCPR 10′ and 30′.ConclusionsThe early and systemic implementation of ECPR after either a 10- or 30-min low-flow was associated with impaired cerebral and systemic hemodynamics after ROSC, as compared to CCPR with epinephrine.

Objective: This systematic review compares survival with favorable neurological outcomes following extracorporeal cardiopulmonary resuscitation (ECPR) versus conventional CPR (CCPR) in adults with refractory cardiac arrest.Methods: We conducted a systematic search of major databases for randomized and observational studies comparing ECPR to CCPR. The primary outcome was survival with a favorable neurological outcome, defined as a Cerebral Performance Category (CPC) of 1 or 2.Results: Eight studies involving 1,676 patients were included. The pooled analysis demonstrated that ECPR was associated with a 21.2 % rate of favorable neurological outcome compared to 16.7 % with CCPR. The combined relative risk (RR) was 1.27 (95 % CI 1.04–1.56), indicating a statistically significant 27 % relative improvement with ECPR. The absolute risk reduction was 4.5 %, with a number needed to treat of 22. However, significant heterogeneity was observed. The magnitude of benefit was highly dependent on patient and system factors, with the most pronounced advantages seen in patients with an initial shockable rhythm and shorter low-flow times. While one randomized controlled trial (ARREST) reported a large, significant effect (RR 6.43), the larger INCEPTION trial found a non-significant effect (RR 1.24).Conclusion: ECPR is associated with a significant improvement in survival with favorable neurological outcomes compared to CCPR. This benefit is not universal and appears greatest in selected populations, particularly those with shockable rhythms and rapid access to a highly organized ECPR system. Successful implementation requires robust protocols for rapid deployment and careful patient selection.

AimDespite improved outcomes with extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) patients, ventilator-associated pneumonia (VAP) remains a significant complication. While prophylactic antibiotics are not recommended for conventional CPR, their effectiveness in ECPR patients remains unclear.MethodsThis was a secondary analysis of the SAVE-J II study, a multicenter, retrospective cohort of OHCA patients treated with ECPR. Patients who died within three days of admission were excluded. The primary outcome was early-onset VAP development, with secondary outcomes being 30-day mortality and neurological outcomes at discharge. The effect of prophylactic antibiotics, administered within 24 h after admission, was estimated by combining propensity score matching and multivariable logistic regression. Missing covariates were multiply imputed.ResultsOf 2157 patients, 919 were included for propensity score matching, yielding a matched cohort of 448. In the matched cohort, prophylactic antibiotics administration was not significantly associated with VAP incidence (aOR, 0.62; 95% CI, 0.39–1.01), although the incidence was numerically lower (24.1% vs 31.3%). No effects were observed in 30-day mortality (aOR, 1.00; 95% CI, 0.64–1.57) or unfavorable neurological outcomes (aOR, 0.92; 95% CI, 0.56–1.52). Sensitivity analyses using different definitions of VAP and population yielded consistent results.ConclusionsAlthough point estimates suggested a possible reduction in VAP, the results did not reach statistical significance, and no improvements in survival or neurological outcomes were detected. Further randomized controlled trials are warranted before advocating routine prophylactic antibiotic use.

BackgroundCardiac arrest (CA) remains a leading cause of mortality and long-term neurological disability. In cases of refractory CA, extracorporeal cardiopulmonary resuscitation (ECPR) may be implemented as a salvage therapy to mitigate hypoxic-ischemic brain injury and improve outcomes. However, the optimal target temperature in the specific context of ECPR remains uncertain. The objective of this study was to evaluate the impact of hypothermia on brain function using a controlled experimental model of ECPR.MethodsTwelve pigs were subjected to 5 min of untreated ventricular fibrillation, followed by 25 min of conventional cardiopulmonary resuscitation (CPR). At 30 min, veno-arterial extracorporeal membrane oxygenation support was initiated, and defibrillation attempts were performed until the achievement of return of spontaneous circulation (ROSC). Following ROSC, animals were randomly assigned to one of two groups: hypothermia (HT), targeting a core body temperature of 33–34 °C, or controlled normothermia (NT), targeting 37–38 °C. All animals underwent continuous multimodal neurological and cardiovascular monitoring. Blood samples were collected at predefined time points to assess circulating biomarkers of organ injury. The primary outcome was the change of brain tissue oxygen tension (PbtO2) over time. Other neurological and hemodynamical parameters were treated as secondary analyses. At 12 h post-ROSC, animals were euthanized via intracardiac injection of potassium chloride. Brain tissues were immediately harvested and appropriately stored for molecular analyses.ResultsA total of 12 pigs were included in the study, with six animals allocated to each group. Baseline characteristics were comparable between the groups and ROSC was achieved in all animals. Throughout the experiment, PbtO₂ gradually declined and intracranial pressure (ICP) increased in both groups; however, no significant differences were observed between groups. Similarly, there were no significant differences in cerebral metabolites, cortical activity, or gene expression in either frontal or parietal brain tissues. Notably, neurofilament light chain (NfL) concentrations were significantly lower at the end of the observation period in the HT group compared to NT (p = 0.04), while neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) levels did not differ significantly between the two groups.ConclusionsHT did not improve cerebral perfusion or metabolic parameters in this refractory cardiac arrest ECPR model; the early decrease in NfL levels requires cautious interpretation and further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40635-025-00841-w.

ABSTRACT OBJECTIVES To evaluate factors associated with automated external defibrillator (AED) application to out-of-hospital cardiac arrest (OHCA) patients. METHODS This retrospective cohort study used data from the All-Japan Utstein and Emergency Transport Registries for 2021. The application of AED was classified according to the bystander defibrillation field in the Utstein data. Cases where an AED was applied and the AED pads were attached were defined as “AED applied” and those with unknown AED application as “AED not applied.” Multivariable logistic regression was used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors related to AED applied. RESULTS A total of 117,790 patients were analyzed (AED applied, n = 12,354 (0.5%); AED not applied, n = 105,436 (89.5%)). Factors associated with AED applied included daytime occurrence (AOR (95% CI), 1.14 (1.08–1.20) vs. nighttime), conventional cardiopulmonary resuscitation (CPR) (2.29 (2.09–2.50) vs. hands-only CPR), dispatcher assistance (2.02 (1.92–2.12)), and occurrence in a school (3.53 (2.58–4.82) vs. public place). Factors associated with AED not applied included age ≥65 years (0.92 (0.84–0.99) vs. 19–64 years), witnessed by family members (0.55 (0.48–0.64) vs. unwitnessed), no bystander CPR (0.28 (0.26–0.30) vs. hands-only CPR), and occurrences in a home (0.01 (0.01–0.01) vs. public place). CONCLUSIONS The application of AED was associated with patient age, witness status, bystander CPR, and incident location. These findings should inform the placement of AEDs and educational strategies.

Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used in adults with refractory cardiac arrest. However, post-resuscitation care in this population remains heterogeneous, evidence-based recommendations are lacking, and most evidence is derived from conventional cardiopulmonary resuscitation. We conducted a scoping review to describe the existing evidence on post-resuscitation care after ECPR. We systematically searched PubMed and Embase from inception to May 19, 2025, for studies reporting on post-resuscitation care in adults treated with ECPR following out-of-hospital or in-hospital cardiac arrest. Findings were extracted and summarized in a narrative format. A total of 133 studies published between 2015 and 2025 were included. The most frequently investigated domains included hemodynamic monitoring and management (30/133, 23%), neurological monitoring and prognostication (22/133, 17%), oxygenation, carbon dioxide, and ventilation (18/133, 14%), complications other than bleeding (15/133, 11%), and coagulation/bleeding (13/133, 9.8%). Other domains included long-term outcomes (8/133, 6.0%), temperature control (8/133, 6.0%), imaging (7/133, 5.3%), organ donation (5/133, 3.8%), and general intensive care management (5/133, 3.8%). While select studies reported associations between specific exposures or interventions and clinical outcomes, the level of evidence was limited by small sample sizes (only 22/133 [17%] included >500 patients), study design (119/133 [90%] were retrospective), and inconsistent outcome reporting. Post-resuscitation care after adult ECPR remains poorly characterized and insufficiently studied. Available evidence across all domains is constrained by heterogeneity, retrospective designs, and small sample sizes. Prospective, well-designed studies are needed to generate robust evidence to guide clinical decision-making and define ECPR-specific post-resuscitation strategies.

Implementing lean six sigma to optimize emergency extracorporeal cardiopulmonary resuscitation process management.

Racial differences in cardiac arrest survival: insights from Minnesota metro data and the University of Minnesota extracorporeal cardiopulmonary resuscitation cohort