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

Laith Alhuneafat; Fares Ghanem; Milos Brankovic; Omar Obeidat; Gaspar Del Rio Pertuz; Alejandra Gutierrez; Ahmad Jabri; Dil Patel; Jason Bartos; Andrea Elliott

doi:10.1016/j.carrev.2025.05.008

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

Cardiovasc Revasc Med. 2026 Jan:82:111-119. doi: 10.1016/j.carrev.2025.05.008. Epub 2025 May 10.

Authors

Affiliations

¹ Division of Cardiovascular Disease, University of Minnesota, Minneapolis, MN, USA. Electronic address: Alhun005@umn.edu.
² Department of Cardiovascular Medicine, Southern Illinois University, Springfield, IL, USA.
³ Division of Cardiovascular Disease, University of Minnesota, Minneapolis, MN, USA.
⁴ Department of Medicine, University of Central Florida, Gainesville, FL, USA.
⁵ Department of Cardiovascular Disease, Henry Ford Health System, Detroit, MI, USA.

PMID: 40393867
DOI: 10.1016/j.carrev.2025.05.008

Abstract

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.

Keywords: Cardiac arrest (OHCA/IHCA); Extracorporeal membrane oxygenation (ECMO); Health disparities; Multivariable regression analysis; Survival predictors.

MeSH terms

Adult
Aged
Cardiopulmonary Resuscitation* / adverse effects
Cardiopulmonary Resuscitation* / mortality
Cardiopulmonary Resuscitation* / trends
Databases, Factual
Extracorporeal Membrane Oxygenation* / adverse effects
Extracorporeal Membrane Oxygenation* / mortality
Extracorporeal Membrane Oxygenation* / trends
Female
Healthcare Disparities / trends
Heart Arrest* / diagnosis
Heart Arrest* / mortality
Heart Arrest* / therapy
Hospital Mortality
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / mortality
Out-of-Hospital Cardiac Arrest* / therapy
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States / epidemiology