• Ingrid Magnet, Wilhelm Behringer, Felix Eibensteiner, Florian Ettl, Jürgen Grafeneder, Gottfried Heinz, Michael Holzer, Mario Krammel, Elisabeth Lobmeyr, Heidrun Losert, Matthias Müller, Alexander Nürnberger, Julia Riebandt, Christoph Schriefl, Thomas Staudinger, Alexandra-Maria Stommel, Christoph Testori, Christian Zauner, Andrea Zeiner-Schatzl, and Michael Poppe.
• Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
• Ann Emerg Med. 2025 Jan 17.

Study ObjectiveExtracorporeal cardiopulmonary resuscitation (eCPR) is a rescue therapy for selected patients when conventional cardiopulmonary resuscitation (CPR) fails. Current evidence suggests that the success of eCPR depends on well-structured in- and out-of-hospital protocols. This article describes the Vienna eCPR program, and the interventions implemented to improve clinical processes and patient outcomes.MethodsIn this retrospective study, we report on all patients with inhospital and out-of-hospital cardiac arrest treated with eCPR at our department between 2020 and 2023. During this period, the program was restructured, including the introduction of out-of-hospital and inhospital algorithms and interprofessional training. The primary endpoint was survival with favorable neurologic outcomes at 6 months, defined as a cerebral performance category score of 1 or 2.ResultsOverall, 192 patients were treated with eCPR. The proportion of patients with favorable neurologic outcomes was 25% (n=48), increasing each year: 15% (5/34) in 2020, 19% (8/42) in 2021, 23% (12/53) in 2022, and 37% (23/63) in 2023. This was particularly true for out-of-hospital cardiac arrest patients: 7% (2/29), 14% (4/29), 17% (7/41), and 32% (16/50), respectively. Simultaneously, rates of witnessed arrest, bystander CPR, and initial shockable rhythm increased, whereas low-flow durations decreased.ConclusionAfter restructuring the Vienna eCPR program, we were able to improve survival rates with favorable neurologic outcomes after eCPR. This improvement was accompanied with increased case volumes, rates of witnessed arrest, bystander CPR, and initial shockable rhythm, and decreased low-flow durations. The learning curve we observed illustrates that outcomes can improve with experience, a summation effect of training, patient selection, and process standardization.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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