Magnet Ingrid, Clodi Christian, Ettl Florian, Grafeneder Jürgen, Holzer Michael, Lobmeyr Elisabeth, Losert Heidrun, Mueller Matthias, Nürnberger Alexander, Stommel Alexandra-Maria, Riebandt Julia, Schriefl Christoph, Schellongowski Peter, Schneeweiss-Gleixner Mathias, Testori Christoph, Zeiner-Schatzl Andrea, Zilberszac Robert, Behringer Wilhelm, Eibensteiner Felix, Poppe Michael
Department of Emergency Medicine, Medical University of Vienna, Austria.
Department of Cardiac Surgery, Medical University of Vienna, Austria.
Resuscitation. 2025 Nov;216:110819. doi: 10.1016/j.resuscitation.2025.110819. Epub 2025 Sep 11.
Extracorporeal cardiopulmonary resuscitation (eCPR) is a rescue therapy for refractory cardiac arrest, with evidence suggesting improved outcomes when performed at experienced centres. Unlike conventional CPR (cCPR), eCPR patients often exhibit delayed recovery. Current guidelines recommend outcome assessment at 1 month or hospital discharge, potentially missing late neurological improvements. This study investigates longitudinal changes in neurological outcomes among eCPR and cCPR patients.
We conducted a single-centre, retrospective cohort study at the Cardiac Arrest Centre Vienna, including adult patients treated with eCPR or cCPR between January 2020 and May 2024. Patients who survived at least 1 month were analysed. The primary endpoint was the difference in the temporal change in favourable neurological outcome (Cerebral performance category, CPC 1-2) between 1 and 6 months in eCPR versus cCPR patients. Secondary endpoints included CPC distribution, survival rates, and patterns of delayed recovery.
Of 912 included patients (209 eCPR, 703 cCPR), 435 were alive at 1 month. In eCPR patients (n = 63), favourable neurological outcome increased from 59 % at 1 month to 87 % at 6 months (p < 0.001), while in cCPR patients (n = 372), it increased from 81 % to 84 % (p = ns). This corresponded to a 29 % versus 3 % increase in patients with a favourable neurological outcome (p < 0.001). There was no change in neurological outcome between 6 and 12 months in either group. Overall, recovery in eCPR patients was prolonged compared to patients after successful resuscitation with cCPR.
Neurological outcomes in eCPR patients frequently continue to improve after 1 month after cardiac arrest. Future eCPR trials should therefore use outcome assessments beyond 1 month to fully capture recovery potential and patient-centred outcomes.
体外心肺复苏（eCPR）是一种用于难治性心脏骤停的抢救治疗方法，有证据表明在经验丰富的中心进行该治疗时预后会得到改善。与传统心肺复苏（cCPR）不同，接受eCPR的患者恢复往往延迟。当前指南建议在1个月或出院时进行预后评估，这可能会遗漏后期的神经功能改善情况。本研究调查了接受eCPR和cCPR的患者神经功能预后的纵向变化。
我们在维也纳心脏骤停中心进行了一项单中心回顾性队列研究，纳入了2020年1月至2024年5月期间接受eCPR或cCPR治疗的成年患者。对存活至少1个月的患者进行分析。主要终点是eCPR患者与cCPR患者在1至6个月之间良好神经功能预后（脑功能分类，CPC 1-2）的时间变化差异。次要终点包括CPC分布、生存率和延迟恢复模式。
在912例纳入患者（209例eCPR，703例cCPR）中，435例在1个月时存活。在接受eCPR的患者（n = 63）中，良好神经功能预后从1个月时的59%增加到6个月时的87%（p < 0.001），而在接受cCPR的患者（n = 372）中，这一比例从81%增加到84%（p = 无统计学意义）。这相当于良好神经功能预后的患者增加了29%，而cCPR患者增加了3%（p < 0.001）。两组在6至12个月之间神经功能预后均无变化。总体而言，与接受cCPR成功复苏的患者相比，接受eCPR的患者恢复时间延长。
心脏骤停后1个月后，接受eCPR的患者神经功能预后通常会持续改善。因此，未来的eCPR试验应使用超过1个月的预后评估，以充分捕捉恢复潜力和以患者为中心的预后情况。
