• Bengt Redfors, Anders Byttner, Daniel Bengtsson, Pia Watson, Lukas Lannemyr, Peter Lundgren, Jakob Gäbel, Araz Rawshani, and Anna Henningsson.
• Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: bengt.redfors@vgregion.se.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 17.

ObjectivesExtracorporeal cardiopulmonary resuscitation (ECPR) can save patients with refractory cardiac arrest; however, according to recent meta-analyses, only 20% of patients achieve favorable outcomes (Modified Rankin Scale 0-3). We aimed to develop and validate an ECPR prediction model to improve patient selection.DesignPrognostic model development and internal validation study.SettingSingle-center study.ParticipantsAll 120 normothermic ECPR patients treated at Sahlgrenska University Hospital between January 2010 and October 2021.InterventionsNone.Measurements And Main ResultsMultivariable logistic regression was used to develop the PRognostic Evaluation of ECPR (Pre-ECPR) score. Model performance was assessed through the area under curve (AUC) and compared with the Extracorporeal Life Support Organization (ELSO) "Example of selection criteria for ECPR" for 1-year survival with favorable outcomes. The positive predictive value (PPV) was calculated. Favorable outcomes occurred in 27.5% of the patients. The Pre-ECPR score, incorporating age, no-flow/initial rhythm (a composite variable), total cardiac arrest time, signs of life, pupil dilation, regional cerebral oxygen saturation, arterial pH, and end-tidal CO2, demonstrated an AUC of 0.87 (95% confidence interval [CI] 0.77-0.93). In internal cross-validation, the AUC of 0.79 (95% CI 0.67-0.88) significantly outperformed the ELSO criteria AUC of 0.63 (95% CI 0.54-0.72, p = 0.012). Pre-ECPR score probabilities >6.4% showed 100% sensitivity and a PPV of 40.5% for favorable outcomes.ConclusionsThe Pre-ECPR score combines multiple weighted predictors to provide a single balanced probability of favorable outcomes in ECPR patient selection. In cross-validation, it demonstrated significantly more favorable discriminatory performance than that of the ELSO criteria.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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