Acute cardiac care & resuscitation
Impact of rhythm changes during CPR on extracorporeal cardiopulmonary resuscitation (ECPR) outcomes: an Extracorporeal Life Support Organization (ELSO) Registry study
Authors' conclusion
In this large, multicenter analysis, both initial and cannulation rhythms were independently associated with survival among ECPR recipients. Survival showed time-dependent variation across rhythm conversions.
Study context
- Population
- Adults (≥18 years) undergoing ECPR, ELSO Registry, 2020–20253,382 in complete case analysis
- Participants
- 5,489 adults
- Exposure
- Initial and cannulation cardiac rhythms in ECPR
- Outcome
- Survival to hospital discharge
- Follow-up
- Hospital discharge
Methodological detailsmulticentre, international registry (ELSO), complete case analysis, multivariable logistic regression
- Multicentre
- International registry (ELSO)
- Complete case analysis
- Multivariable logistic regression
Main finding
As reported in the abstract
Survival to hospital discharge, by initial rhythm
Each group vs initial VFOdds ratio (95 % CI)
Initial PEA
0.59(0.48–0.71)
Initial asystole
0.64(0.47–0.86)
Observational data: associations, not effects.
Further findings
| Outcome | OR | P value | |
|---|---|---|---|
| Survival, by rhythm at cannulation · worse outcomes | 0.61 (95 % CI 0.38–0.99) | ||
| Survival decline with prolonged CPR (60 vs 40 min), by rhythm at cannulation — 60 min CPR vs 40 min CPR · asystole at cannulation (steepest) | 0.64 (CI 0.54–0.76) | P < 0.001 | |
| Survival decline with prolonged CPR (60 vs 40 min), by rhythm at cannulation — 60 min CPR vs 40 min CPR · VF at cannulation (most gradual) | 0.84 (CI 0.76–0.93) | P = 0.001 | |
| 0.20.5125Odds ratio (log scale) |
Survival, by rhythm at cannulation
- Survival highest with persistent ventricular fibrillation (VF) or conversion from non-shockable to VF; lowest with conversion to or persistent non-shockable rhythm
Original publication
Impact of rhythm changes during CPR on ECPR outcomes: an ELSO Registry study. Resuscitation. Published 30 December 2025. doi:10.
Summarised from the published abstract; every number is checked against it