• Jeong Ho Park, Kyoung Jun Song, Sang Do Shin, Young Sun Ro, and Ki Jeong Hong.
• Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea.
• Emerg Med Australas. 2019 Dec 1; 31 (6): 1073-1081.

ObjectivesThe association between the time from arrest to extracorporeal cardiopulmonary resuscitation (ECPR) and survival from out-of-hospital cardiac arrest (OHCA) is unclear. The aim of this study was to determine whether time to ECPR is associated with survival in OHCA.MethodsWe analysed the Korean national OHCA registry from 2013 to 2016. We included adult witnessed OHCA patients with presumed cardiac aetiology who underwent ECPR. Patients were excluded if their arrest times or outcomes were unknown. The primary outcome was survival to discharge. Multivariable logistic regression analysis controlling for potential confounders was conducted and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated to determine the association between time to ECPR and survival.ResultsThere were 40 352 witnessed OHCAs with presumed cardiac aetiology. One hundred and forty patients had ECPR applied on arriving at their ED, 13 of these patients survived to discharge and seven were neurologically intact. Median time from arrest to ECPR was 74 min (IQR 61-90). Time from arrest to ECPR was significantly and inversely associated with survival to discharge for every 10 min increase in time (AOR 0.73, 95% CI 0.53-1.00) in 10 min intervals. AOR for time from arrest to ECPR ≤60 min was independently associated with improved survival (AOR 6.48, 95% CI 1.54-27.20).ConclusionEarly initiation of ECPR is associated with improved survival after OHCA. Because we analysed a nationwide OHCA registry, which lacks uniform selection criteria for ECPR, further prospective study is warranted.© 2019 Australasian College for Emergency Medicine.

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