Predictors of extracorporeal membrane oxygenation utilization and survival during cardiopulmonary resuscitation in out and in-hospital cardiac arrest

Introduction: Extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) has shown promise in managing both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). Methods: We analyzed hospital discharge records from the National Inpatient Sample of adult individuals who underwent ECPR between 2016 and 2020. Multivariable regression analyses were conducted to identify factors influencing ECPR utilization and survival. Results: Among 1,585,960 patients (901,470 OHCA, 684,490 IHCA), ECPR utilization rates were 1 % for OHCA and 1.4 % for IHCA, with inpatient mortality rates of 52 % and 67 %, respectively. In OHCA, ECPR was more likely in patients from higher-income areas, those with Medicaid/private insurance, systolic heart failure, shockable rhythms, and Hispanic/other races but less likely in those over 65, with patients with history of atrial fibrillation, diabetes, cerebrovascular accident, or COPD. In IHCA, ECPR was more common in larger hospitals, higher-income areas, and those with private insurance but less frequent in Black patients, those over 65, or with prior cerebrovascular accidents, COPD, diabetes, or end-stage renal disease. In OHCA ECPR, Asian race (aOR: 2.31), diabetes (aOR: 1.29), and liver disease (aOR: 1.77) predicted mortality, while shockable rhythms (aOR: 0.75), systolic heart failure (aOR: 0.67), and treatment in southern states (aOR: 0.72) predicted survival. In IHCA ECPR, acute myocardial infarction (aOR: 0.73) and private insurance (aOR: 0.63) were associated with improved survival, whereas liver disease (aOR: 1.59) predicted higher mortality. Conclusion: We highlight the selective nature of ECPR utilization between OHCA and IHCA and the distinct survival predictors in each setting. Further research is needed to refine selection criteria and optimize patient outcomes.