Acute cardiac care & resuscitation
Earlier Versus Later Extracorporeal Cardiopulmonary Resuscitation in Refractory Out-of-Hospital Cardiac Arrest: A Nationwide Sequential Landmark Target Trial Emulation
Main finding · Weighted 30-day survivalResult — go to the resultAdjusted risk difference +15.0 percentage points 95% CI 8.0–22.0Authors' conclusion
ECPR was associated with improved survival and neurological outcomes at every landmark, including initiation beyond 60 minutes, where weighted 30-day survival with continued conventional CPR was 3.2%. Benefit was largest with early initiation but did not disappear at the commonly applied 60-minute benchmark, which may be overly restrictive for selected patients in capable systems.
Study context
- Population
- Patients with refractory out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology still receiving emergency department (ED) CPR 15 minutes after ED arrival909 received extracorporeal cardiopulmonary resuscitation (ECPR)
- Participants
- 58,668 patients
- Exposure
- ECPR vs control
- ECPRn = 909
- Outcome
- Weighted 30-day survival
- Follow-up
- 15-minute landmark
Methodological detailsKorean nationwide OHCA registry (2016-2023), propensity score overlap weighting with 22 covariates
- Korean nationwide OHCA registry (2016-2023)
- Propensity score overlap weighting with 22 covariates
Main finding
As reported in the abstract
Adjusted risk difference
+15.0 percentage points
95% CI 8.0–22.0
P < 0.001
By group
Observational data: associations, not effects.
Further findings
Weighted 30-day survival · 30-minute landmark
adjusted risk difference (percentage points) +14.4 (10.4–18.4) · P < 0.001
Weighted 30-day survival · 60-minute landmark
adjusted risk difference (percentage points) +7.7 (3.7–11.7) · P < 0.001
Favourable neurological outcomes
- Favourable neurological outcomes showed a similar pattern
Exploratory timing-gradient analysis
- The adjusted risk difference decreased with longer door-to-ECMO times but remained statistically significant through 120 minutes
- Exploratory
Original publication
Summarised from the published abstract; every number is checked against it