Effect of time to extracorporeal cardiopulmonary resuscitation on survival outcomes in in-hospital cardiac arrest patients

Aims: This study explores the association between time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation and survival in patients with in-hospital cardiac arrest (IHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This retrospective study included IHCA patients who received ECPR at the University of Minnesota Medical Center from 2016 to 2024. The primary outcome was survival to discharge; the secondary outcome was favorable neurological status, defined as Cerebral Performance Category score of 1–2. The association between time from arrest to ECPR, referred to as resuscitation time, and survival was evaluated with logistic regression analyses. Results: A total of 100 patients were included. The median age was 61 years and the median resuscitation time was 33 min. Overall, 30 % of patients survived to discharge and 25 % had favorable neurological outcomes. Survival was significantly higher in patients with resuscitation duration less than 30 min compared to those with duration over 30 min (53.1 % vs 19.1 %, p = 0.001). Survivors had a significantly shorter median time from arrest to ECPR than non-survivors (26 vs. 35 min, p = 0.005). In a multivariable analysis, resuscitation duration remained independently associated with survival to discharge (p = 0.04). Conclusion: Shorter resuscitation time is a key determinant of survival in IHCA patients, with optimal outcomes achieved when ECMO is initiated within 30 min of arrest.