• Kristin Alm-Kruse, Gro Sørensen, Svein Are Osbakk, Kjetil Sunde, Bjørn Bendz, Geir Øystein Andersen, Arnt Fiane, Ove Andreas Hagen, and Jo Kramer-Johansen.
• Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: Kellings@ous-hf.no.
• Resuscitation. 2021 May 1; 162: 35-42.

AimTo compare the outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA) fulfilling the criteria for extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an ECPR protocol, whether the patient received ECPR or not.MethodsWe compared cardiac arrest registry data before (2014-2015) and after (2016-2019) implementation of the ECPR protocol. The ECPR criteria were presumed cardiac origin, witnessed arrest with ventricular fibrillation, bystander CPR, age 18-65, advanced life support (ALS) within 15 min and ALS > 10 min without return of spontaneous circulation (ROSC). The primary outcome was 30-day survival; the secondary outcomes were sustained ROSC, neurological outcome and the proportion of patients transported with ongoing ALS.ResultsThere were 1086 and 3135 patients in the pre- and post-implementation sample; 48 (4%) and 100 (3%) met the ECPR criteria, respectively. Of these, 21 (44%) vs. 37 (37%) were alive after 30 days, p = 0.4, and 30 (63%) vs. 50 (50%) achieved sustained ROSC, p = 0.2. All survivors in the pre-implementation sample had cerebral performance category 1-2 vs. 30 (81%) in the post-implementation sample, p = 0.03. Of the patients fulfilling the ECPR criteria, 7 (15%) and 26 (26%), p = 0.1, were transported with ongoing ALS in the pre- and post-implementation sample, respectively.ConclusionsThere were no differences in 30-day survival or prehospital ROSC in patients with refractory OHCA before and after initiation of an ECPR protocol.Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

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