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April 19, 2026Open Access

Long-term Neurological Outcomes After Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest: A 14-Year Single-Center Cohort Study

Key Points

This study aims to evaluate long-term neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest.
Conducted a retrospective observational study at an Italian ECMO center.
Included adult patients treated with ECPR for in-hospital and out-of-hospital cardiac arrest.
Assessed long-term neurological performance using the Cerebral Performance Category (CPC) scale.
Performed multivariable and latent class analyses to identify independent predictors.
17.3% of patients achieved CPC 1-2 at six months post-discharge.
Higher CPC rates were noted in in-hospital cardiac arrest (28.2%) compared to out-of-hospital (10.1%).
Independent predictors of favourable outcomes included younger age, initial shockable rhythm, and shorter low-flow duration.
Establishing pre-treatment selection criteria improved survival rates but risked missing some potential recoveries.

Abstract

Background.Extracorporeal Cardiopulmonary Resuscitation (ECPR) via Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO) is a viable treatment for refractory cardiac arrest (r-CA).Data on longterm outcomes and predictors of favourable neurological prognosis remain limited, and definitive patientselection recommendations are lacking.Methods.We conducted a retrospective observational study of adult patients treated with ECPR for inhospital (IHCA) and out-of-hospital (OHCA) r-CA at an Italian ECMO centre between 2011 and 2024.The primary outcome was long-term neurological performance, measured by the Cerebral Performance Category (CPC) scale six months after hospital discharge.Multivariable and latent class analyses assessed independent predictors and explored distinct pre-ECPR phenotypes.Results.Among 295 consecutive patients (117 IHCA; 178 OHCA), 17.3% achieved CPC 1-2 at six months (28.2%IHCA vs 10.1% OHCA; p<0.0001), and 4.4% survived with severe long-term neurological sequelae (CPC 3-4).Independent predictors of CPC 1-2 were younger age (OR 0.95 per year, 95% CI 0.92-0.98),an initial shockable rhythm (aOR 2.7; 95% CI 1.11-7.04),and shorter low-flow duration (OR 0.95 per minute increase, 95% CI 0.93-0.97).Stepwise selection based on these criteria progressively increased the proportion of favourable survivors but excluded a small proportion who might have recovered.Conclusions.These results emphasise the importance of establishing pre-treatment selection criteria to optimise ECPR use and enhance long-term neurological outcomes.Age, initial rhythm, and low-flow time are key determinants, and exploratory phenotype-based analyses suggest multidimensional patient characterisation may complement traditional selection criteria..

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