Mechanical versus manual chest compressions during ECPR in the catheterization laboratory

BACKGROUND: Cardiac arrest occurring in the catheterization laboratory (CathLab) carries a high risk of mortality, especially when effective circulation cannot be restored immediately. Although extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used in this context, there is still limited evidence comparing different chest compression strategies. This study aimed to assess clinical outcomes associated with mechanical versus manual chest compression approaches during ECPR in the CathLab. METHODS: We performed a retrospective single-center observational cohort study from 2018 to 2025, including patients who experienced cardiac arrest in the CathLab and received ECPR. Patients were divided into two groups according to the chest compression strategy used during resuscitation: the mechanical chest compression group (mechanical CPR) and the manual chest compression group (manual CPR). The primary endpoint was low-flow time. Secondary endpoints included procedural characteristics and and clinical outcomes (survival to hospital discharge, favorable neurological outcome (CPC 1-2)). RESULTS: A total of 58 patients were included in the analysis, including 22 patients in the mechanical CPR group and 36 in the manual CPR group, with comparable baseline characteristics between groups. Low-flow duration was significantly shorter in the mechanical CPR group compared with the manual CPR group (34 [22-53] min vs. 41 [28-63] min, p = 0.024). No significant differences were observed between groups regarding return of spontaneous circulation (ROSC) prior to cannulation (9.1% vs. 13.9%, p = 0.698), survival to ICU discharge (27.3% vs. 22.2%, p = 0.756), survival to hospital discharge (22.7% vs. 19.4%, p = 0.752), or favorable neurological outcome at discharge (22.7% vs. 13.9%, p = 0.481). Univariable analysis demonstrated that favorable neurological survival (CPC 1-2) was significantly associated with the presence of a shockable rhythm (90.0% vs. 47.9%, p = 0.017), shorter low-flow duration (35 [20-44] min vs. 42 [30-61] min, p = 0.012), shorter cannulation time (12 [7-13] min vs. 14 [11-18] min, p = 0.038), and ROSC prior to cannulation (40.0% vs. 6.3%, p = 0.013). CONCLUSIONS: In patients with cardiac arrest undergoing ECPR in the CathLab, mechanical chest compressions were associated with shorter low-flow duration but were not associated with improved survival or neurological outcomes compared with manual CPR.