Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest: A Comparative Cohort Study from the First ECPR Program in Brazil

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue therapy for refractory in-hospital cardiac arrest (IHCA), but Brazilian data are scarce. We compared ECPR with conventional CPR (cCPR) at the first Brazilian center with a protocolized ECPR program. Methods Retrospective single-center cohort at Einstein Hospital Israelita, São Paulo. Adults (18 to 75 years) with witnessed and refractory IHCA fulfilling institutional ECPR eligibility were included. The cCPR cohort (2017 to 2025) comprised eligible patients who did not receive ECPR due to absence of 24/7 ECMO coverage; the ECPR cohort (2020 to 2025) included all protocolized cases. The primary outcome was hospital survival with favorable neurological outcome (Cerebral Performance Category, CPC, of 2 or less). Groups were compared descriptively; survival was estimated by the Kaplan-Meier method with the log-rank test, and the absolute risk reduction and number needed to treat were calculated. Results Thirty-eight patients were analyzed (16 ECPR, 22 cCPR). Hospital survival was higher in the ECPR group (43.7% vs 13.6%, p=0.04), corresponding to an absolute risk reduction of 30.1% (95% CI 1.9 to 58.3) and a number needed to treat of 4. Estimated 30-day survival was 50.0% versus 12.1% (log-rank p=0.02). All survivors achieved CPC of 2 or less. The groups differed substantially at baseline, including in age and sex. Conclusions In this first Brazilian single-center cohort, hospital survival was higher and neurological recovery uniformly favorable among patients treated with ECPR for refractory IHCA. These descriptive findings are hypothesis-generating and support the feasibility of a structured in-hospital ECPR program in the Brazilian setting.