ID:1 FC-NP2-3 Effectiveness of Therapeutic Hypothermia After ECPR

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) improves survival in refractory cardiac arrest but neurological recovery remains a key unmet challenge. Therapeutic hypothermia (TH, 32–34 °C) provides neuroprotection by reducing cerebral metabolism and mitigating ischemia–reperfusion injury, yet evidence from Asian populations, especially Taiwan, China, is limited. Methods: We conducted a retrospective case-control study (2015–2023) at a tertiary medical center in central Taiwan, China. Among 218 refractory OHCA patients undergoing ECPR, 82 received TH and 136 received standard care (No-TH). TH was delivered via surface or intravascular cooling for 24–36 h, followed by controlled rewarming. Primary outcomes were survival (in-hospital), neurological status at discharge [Cerebral Performance Category, CPC], and bleeding complications. Logistic regression and group comparisons (χ2/t-test) identified predictors of survival and favorable neurological outcome. Results: The ECPR+TH group demonstrated significantly higher survival and greater CPC 1–2 proportion (favorable neurological outcome) than No-TH (both p < 0.01). Bleeding events showed no significant difference (p = 0.287). Multivariable analysis indicated TH as an independent predictor of improved neurological outcomes (β = –0.578, p = 0.001). Poorer CPC scores correlated with longer CPR duration, higher APACHE II scores, bleeding, comorbidities, and shock indices. Conclusion: ECPR combined with TH improves survival and neurological recovery (CPC 1–2) without increasing bleeding risk. These data support early TH integration in ECPR protocols as a neuroprotective strategy prioritizing quality of survival, not survival alone. Prospective multicenter validation is needed to optimize cooling selection, timing, and rewarming precision in Asian cohorts.