35: Clinical Outcomes of Extracorporeal Cardiopulmonary Resuscitation (ECPR) in Adults: Insights from a Single Indian Tertiary Care Center

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) refers to the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during cardiac arrest when conventional cardiopulmonary resuscitation fails to achieve sustained return of spontaneous circulation. ECPR restores systemic perfusion and oxygenation, serving as a bridge to definitive therapy. Although randomized controlled trials in in-hospital cardiac arrest (IHCA) are limited, observational studies suggest feasibility and potential survival benefit in carefully selected patients. Methods: We conducted a retrospective analysis of all ECPR cases performed at our center between 2021 and 2025. Demographic data, arrest characteristics, etiology, initial rhythm, cardiopulmonary resuscitation duration, complications, and outcomes were reviewed. Results: Of 151 ECMO cases during the study period, 14 (9.2%) were ECPR. All events were witnessed IHCAs. The mean age was 52 years, and the majority of patients were male (64%). Eight patients (57%) were successfully weaned from VA-ECMO, and six (42%) survived to hospital discharge. Among survivors, five (35%) achieved good neurological recovery. Etiologies included acute coronary syndrome in nine patients (64%), pulmonary embolism in four (29%), and toxin ingestion in one (7%). Initial arrest rhythm was shockable in 10 patients (71%) and non-shockable in four (29%). Low-flow time ranged from 15 to 42 minutes, with a mean duration of 28.5 minutes. Major complications included severe hypoxic–ischemic encephalopathy in two patients (14%) and major bleeding in two patients (14%), including one case each of disseminated intravascular coagulation and intracranial hemorrhage. Conclusion: ECPR represents a lifesaving strategy for selected patients with refractory in-hospital cardiac arrest, offering meaningful survival and favorable neurological outcomes when initiated promptly. Its implementation remains largely confined to tertiary care centers due to significant requirements for infrastructure, cost, and specialized expertise.