Pumping the Brakes: Extracorporeal Cardiopulmonary Resuscitation Candidacy in an Urban Tertiary Care Setting

There is increasing evidence to support the use of Extracorporeal Membrane Oxygenation (ECMO) during cardiac arrest, termed Extracorporeal Cardiopulmonary Resuscitation (ECPR). ECPR has great potential to improve cardiac arrest survival, however it is also a very resource intensive process, and not every patient would benefit from this therapy. Although academic centers are often well positioned to develop ECPR programs given their existing resources and infrastructure, their patient population may also include a higher burden of comorbid illness and suboptimal arrest characteristics that can limit eligibility. The purpose of this study was to evaluate the incidence of patients meeting ECPR criteria during the implementation of a new ECPR program, and to examine the frequency of characteristics that may exclude patients from this therapy.

We conducted a single-center prospective observational study at a large academic medical center in the southeastern United States over a one-year period (January 2024–December 2024). All patients who presented to the Emergency Department with either non-traumatic out of hospital cardiac arrest (OHCA) or experiencing cardiac arrest in the Emergency Department were included. Baseline demographics and arrest characteristics were collected to assess eligibility for ECPR. We used the following criteria for ECPR eligibility: Age ≤ 65, witnessed arrest with no-flow time ≤ 5 min, total arrest time ≤ 20 min, never in asystole, no severe/end-stage medical illness or neurologic disability.

During the study period, 156 non-traumatic cardiac arrests were recorded. No patients were excluded. Twelve patients (7.69%) met institutional criteria for ECPR candidacy. The most common reasons for exclusion were unwitnessed arrest (70.21%), prolonged downtime (64.89%), contraindicating baseline medical conditions (41.67%), age above the institutional cutoff (39.74%), rhythm of asystole (26.92%), and return of spontaneous circulation prior to ECPR initiation (15.38%).

In this single-center cohort of cardiac arrests occurring over one year, fewer than 8% of patients met criteria for ECPR. These findings underscore the importance of evaluating an institution’s local patient population when developing a new ECPR program, as eligibility rates may directly influence resource utilization, staffing demands, and program stability.