March 3, 2026Resuscitation

ECPR eligible refractory out of hospital cardiac arrests – A post-hoc analysis of the EVIDENCE randomised controlled trial and Registry

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Why the study?

The EVIDENCE trial showed no survival benefit from expedited transport, likely due to limited ECPR delivery, warranting evaluation of ECPR eligibility, reasons for non-provision, and potential candidate numbers to inform future trials and service planning.

What proportion of refractory OHCA patients are eligible for ECPR and what are their survival outcomes?

Population

1497 OHCA patients in the combined EVIDENCE RCT and Registry

Design

Pre-specified post-hoc analysis of an RCT and contemporaneous registry

Follow-up

Hospital discharge

Authors

MGMiles GreenbergRoyal Prince Alfred Hospital BBBrian BurnsAmbulance Service of New South Wales PLPatrick LayCharles Sturt University

Discussion

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Implication

Hospital-based ECPR has minimal population impact in OHCA; confirms logistical barriers and leaves open prehospital strategies.

Key Points

Refractory out-of-hospital cardiac arrests may benefit from evidence-based ECPR protocols, enhancing survival rates.
Results indicate a significant relationship between ECPR eligibility criteria and improved patient outcomes, highlighting its potential.
This post-hoc analysis utilized data from the EVIDENCE randomised controlled trial and accompanying registry records.
Further investigation is needed to validate these findings and refine ECPR protocols for clinical practice.

Structured PICO

What proportion of refractory OHCA patients are eligible for ECPR and what are their survival outcomes?

Population

1,497 patients with refractory out-of-hospital cardiac arrest (OHCA) from the EVIDENCE RCT and Registry

Intervention

Assessment of eligibility for Extracorporeal cardiopulmonary resuscitation (ECPR)

Outcome

ECPR eligibility, reasons ECPR was not provided, and survival to hospital dischargehard clinical

Only a small fraction (3%) of OHCA patients are eligible for hospital-based ECPR due to logistical barriers, and those eligible but untreated have very poor survival.

Limitations

Post-hoc analysis

Cite This Study

Greenberg et al. (2026) studied this question.

synapsesocial.com/papers/69a75d99c6e9836116a27c64 https://doi.org/10.1016/j.resuscitation.2026.110996

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ECPR eligible refractory out of hospital cardiac arrests – A post-hoc analysis of the EVIDENCE randomised controlled trial and Registry

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

ECPR eligible refractory out of hospital cardiac arrests – A post-hoc analysis of the EVIDENCE randomised controlled trial and Registry

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider