Background: Out-of-hospital cardiac arrest (OHCA) carries a substantial global mortality burden, extracorporeal cardiopulmonary resuscitation (ECPR) benefits carefully selected cases. Heterogeneous selection risks futile support or missed opportunities. Methods: Between January 2019 and December 2025, consecutive OHCA-ECPR activations at a Hong Kong tertiary ECMO centre emergency department were included. Structured criteria classified patients by adherence to unfavourable/favourable factors and ECMO initiation into four groups. The primary outcome was survival to hospital discharge. Results: Among 282 activations, ECPR survival was 31.8% (21/66) and 6.9% (15/216) for non-ECPR patients, with adherence demonstrating distinct outcomes (Table 1). ECMO initiation without and with unfavourable factors: 38.1% (16/42) vs 20.8% (5/24) survival, while non-initiation without and with unfavourable factors: 30.6% (11/36) vs 2.2% (4/180) survival. The survival for ECMO despite unfavourable factors included age > 75 (2/2 survived, 100%), unwitnessed arrest (2/7, 28.6%), asystole (1/11, 9.1%), none survived when end-tidal carbon dioxide was < 1.3 kPa or unwitnessed arrest coexisted with asystole The survivors after non-ECPR despite absence of unfavourable factors (11/36) all achieved sustained ROSC in the emergency department. Conclusion: Structured ECPR criteria enhance appropriate patient selection, concentrating resources on suitable candidates. Small sample size limits interpretation, while human factors driving decision deviations warrant further study.
Lau et al. (Mon,) studied this question.
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