Key result
Delayed ECPR initiation is linked to decreased survival, with delays beyond 21 minutes dropping survival below ~10%.
Why the study?
The upper time limit for effective ECPR initiation and the influence of advanced age on this threshold in OHCA patients remain uncertain despite existing guidelines.
Cohort (n=483)
Yes
May support expediting ECPR in elderly arrest; leaves open causal thresholds for prospective trials.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a critical rescue strategy for refractory out-of-hospital cardiac arrest (OHCA), but its success is highly dependent on patient selection and timely initiation [ 1 ]. Older age and prolonged extracorporeal membrane oxygenation (ECMO) initiation time are known to negatively affect outcomes [ 2 , 3 ]. Guidelines recommend initiating ECMO within 60 min of cardiac arrest, and experts advocate for early consideration of ECPR [ 1 ]. Despite these recommendations, the upper time limit for ECPR effectiveness remains uncertain, particularly in older OHCA patients. This study aims to define the upper limit for ECPR initiation time and investigate how advanced age influences this threshold.
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Kim et al. (2025) conducted a cohort in Non-traumatic out-of-hospital cardiac arrest (OHCA) (n=483). Longer ECPR initiation time vs. Shorter ECPR initiation time was evaluated on Survival-to-discharge rate (OR 0.97, 95% CI 0.95-0.98, p=0.003). Longer ECPR initiation time was independently associated with decreased survival to discharge (adjusted OR 0.97), with delays beyond 21 minutes dropping survival probability below 10% in elderly patients.
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