Cost-effectiveness in adult patients with cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation

Extracorporeal cardiopulmonary resuscitation (ECPR) is a salvage therapy for refractory cardiac arrest (CA) in adults. However, its high cost, technical complexity, and prolonged support requirements necessitate critical evaluations of cost-effectiveness. This retrospective study enrolled 203 adult patients undergoing ECPR with hospitalization duration more than 24 h between January 2020 and December 2024. The incremental cost-effectiveness ratio (ICER) was calculated to compare in-hospital versus onsite ECPR, and shockable versus non-shockable rhythm groups. A stratified incremental cost-effectiveness evaluation was performed to examine the association between ECMO support duration and early survival outcomes. The discharge survival rate was 30.05% (23.7% in the full adult ECPR cohort including patients with hospitalization duration less than 24 h). The ECMO support duration was 29.00 (IQR: 13.00–67.00) hours. The median treatment cost was 156,653.23 (IQR: 116,097.78–264,884.16) CNY ( $21,984.87 [IQR: 16,293.28-37,174.11]). There was no significant difference in the survival rate between onsite ECPR and in-hospital ECPR in OHCA patients (25.00% vs. 34.25%, P = 0.743), and the ICER of the two groups was 391.53 CNY ($54.95). The survival rate in the shockable rhythm group was significantly greater than the non-shockable rhythm group (38.82% vs. 23.73%, P = 0.021), with an ICER of 2,926.55 CNY ($410.71). Compared with adult CA patients with ECMO support duration ≤ 24 h, those with ECMO support > 24 h exhibited a higher survival rate( P <0.05). Survival outcomes were comparable between in-hospital ECPR and onsite ECPR in OHCA patients. Shockable rhythm predicted better survival and served as a prognostic and triage marker. ECMO support duration is associated with survival rate in adult patients undergoing ECPR. However, further large multicenter studies are needed to confirm these results.