Long-term outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest: Analysis of EXCEL registry data.

Abstract

OBJECTIVE: To describe the six-month functional outcomes of patients who received extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA) in Australia. DESIGN: Secondary analysis of EXCEL registry data. SETTING: EXCEL is a high-quality, prospective, binational registry including adult patients who receive extracorporeal membrane oxygenation (ECMO) in Australia and New Zealand. PARTICIPANTS: Patients reported to the EXCEL registry who received ECPR following IHCA and had the six-month outcome data available were included. MAIN OUTCOME MEASURES: The primary outcome was functional outcome at six months measured using the modified Rankin scale (mRS). The secondary outcomes included mortality, disability, health status, and complications. RESULTS: Between 15th February 2019 and 31st August 2022, 113/1251 (9.0%) patients in the registry received ECPR following IHCA (mean age 50.7 ± 13.7 years; 79/113 (69.9%) male; 74/113 (65.5%) non-shockable rhythm). At 6 months, 37/113 (32.7%) patients were alive, most (27/34 [79.4%]) with a good functional outcome (mRS 0-3). Patients had increased disability [WHODAS % Score 25.58 ± 23.39% vs 6.45 ± 12.32%; mean difference (MD) [95% (confidence interval) CI] -19.13 (-28.49 to -9.77); < 0.001] and worse health status [EuroQol five-dimension, five-level (EQ-5D-5L) index value 0.73 ± 0.23 vs. 0.89 ± 0.14; MD (95% CI) 0.17 (0.07 to 0.26); = 0.003] at six months compared with the baseline. The patients reported a median of 4.5 (2-6) complications at six-month follow-up. CONCLUSION: One in three patients who received ECPR following IHCA were alive at six months and most had a good functional outcome. However, survivors reported higher levels of disability and a worse health status at six months compared with the baseline and ongoing complications were common.