ArticleCritical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine2026
The effect of initial rhythm on patient outcome in refractory cardiac arrest requiring extracorporeal cardiopulmonary resuscitation: A retrospective, multicentre registry cohort study.
Article in Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To determine the effect of initial rhythm on 6-month survival with favourable functional outcomes in patients supported with extracorporeal cardio pulmonary resuscitation (ECPR) for in-hospital cardiac arrest and out-of-hospital cardiac arrest (IHCA and OHCA).Design/Setting/Participants: This multicentre cohort study used secondary data from the EXCEL registry, a binational extracorporeal membrane oxygenation (ECMO) database across Australia and New Zealand. Adults receiving ECPR between February 2019 and December 2022 were included. Main outcome measures: The primary outcome was 6-month survival with a favourable functional outcome, defined using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 (12-item survey). Secondary outcomes included: survival (intensive care unit [ICU], hospital, 90- and 180-day), duration of ECMO and ventilation, ICU and hospital length of stay, and work status at 6 months. Results: Among 249 patients, 123 (49.4%) had an initial shockable rhythm and 126 (50.6%) had a nonshockable rhythm. Overall, 16% (40/249) survived with favourable functional outcomes. Rates were higher in the shockable group (21% vs. 11%, p = 0.031), despite the non-shockable group having more witnessed arrests (98 vs. 90%, p = 0.005) and shorter low-flow times (46.8 vs 65.5 min, p = 0.003). Survivors with a nonshockable rhythm had longer ICU (19.8 vs. 12.7 days, p = 0.028) and hospital stays (39.6 vs. 27.0 days, p = 0.003). Unemployment due to health issues at 6 months was similar between the shockable (14/40 [35%]) and nonshockable (12/32 [37.5%]) groups (p = 0.826). Conclusions: An initial shockable rhythm was associated with higher 6-month survival with favourable functional outcomes after ECPR. Larger studies are needed to confirm whether rhythm-guided selection may improve patient outcomes.
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