Feasibility and outcomes of anaesthesiology- and intensive care-led ECPR in a hospital without cardiac surgery: a 2.5-year prospective registry

Extracorporeal cardiopulmonary resuscitation (ECPR) has been demonstrated to yield positive outcomes in cases of refractory cardiac arrest when implemented within strict time frames. The majority of ECPR programmes are operational within the confines of cardiac surgery centres, with the assistance of surgical teams and perfusionists for the processes of cannulation and circuit management. The present study evaluated the feasibility, safety and outcomes of an anaesthesiology-intensive care-led ECPR programme delivered in a university hospital without on-site cardiac surgery. A prospective registry study was conducted of consecutive adults who underwent extracorporeal membrane oxygenation (ECMO) for refractory out-of-hospital cardiac arrest at a single supraregional centre from May 2023 to October 2025. The selection of patients followed predefined criteria adapted from Extracorporeal Life Support Organization (ELSO) guidance. All cannulations were performed percutaneously under ultrasound guidance by anaesthesiology and intensive care specialists. The primary outcomes of the study were survival to hospital discharge and 3-month survival with favourable neurological status, as measured by the Cerebral Performance Category Scale (CPC) score, which ranges from 1 to 2. Secondary outcomes encompassed the success rate of cannulation, the time interval between cannulation and the occurrence of arrest, and periprocedural complications. A total of 42 patients were included in the study, with a median age of 48 years (IQR 22). The male: female ratio was 83.3:16.7. The most prevalent aetiologies were acute myocardial infarction (38.1%), electrical storm (21.4%), and pulmonary embolism (14.3%). Cannulation was performed in the emergency department (ED) (57.1%; n = 24), the intensive care unit (ICU) (31.0%; n = 13), and the cardiac catheterisation laboratory (Cath-lab) (11.9%; n = 5). The median cannulation time was 15 min (IQR 6), and the median arrest-to-flow time was 59.5 min (IQR 32). It was found that all cases achieved an ECMO flow rate of at least 3.0 L·min⁻¹. At the 3-month mark, the overall survival rate was recorded at 28.6% (12 out of 42 patients), while the favourable neurological outcome, categorised as CPC 1–2, was documented at 23.8% (10 out of 42 patients). Cannulation-related complications occurred in 4.8% (2/42) of cases, and no instances of pneumothorax, cardiac tamponade, aortic dissection, or mechanical ECMO complications were observed. Peripheral cannulation-site bleeding occurred in 31.0% (13/42), distal limb ischaemia in 38.1% (16/42), and these were managed conservatively. Renal replacement therapy was required in 26.2% (11/42) of cases. In 7.1% of cases (3/42), veno-veno-arterial (VVA) ECMO conversion was necessary due to inadequate venous drainage. The implementation of a protocolised, ultrasound-guided, anaesthesiology-intensive care-led ECPR programme is a feasible prospect for a centre that does not have on-site cardiac surgery or perfusionists. This model achieved universal cannulation success, rapid time to ECMO support, and neurological outcomes within ranges reported in the literature.