Conclusion:
Physician adjudicated etiology and origin of cardiac arrest, even when
considered along with arrest rhythm, may not be predictive of survival
to discharge in ECPR. Patients who are younger, arrested in the
emergency department, and arrested from a pulmonary embolism may
represent a population who benefits from ECPR that warrants future
study. The excellent neurological status of those who survive to
discharge demonstrated in this study serves as a justification for its
continued use and optimization.
The lack of correlation between etiology, origin, rhythm, and outcome is
indicative of the underlying heterogeneity of arrest patients. This
heterogeneity poses a fundamental challenge to studying the
appropriateness of ECPR across the diverse care settings and patient
populations. Ultimately, ECPR survival may depend more on resuscitation
metrics such as CPR duration or quality than patient- or arrest-specific
characteristics. In order to determine who may benefit most, we must
focus on improving our ability to clinically phenotype peri-arrest
patients, as well as understanding how the epidemiology of in-hospital
cardiac arrest is changing over time as medical advances continue to
alter the natural history of many common underlying conditions and risk
factors. Further studies are needed to elucidate the factors that can
help determine who will derive the greatest benefit from ECPR in order
to better guide institutions on how to deploy this resource-intensive
but potentially life-saving therapy.