Extracorporeal Cardiopulmonary Resuscitation for Perioperative Cardiac Arrest in Noncardiac Surgery: A Nationwide...

Perioperative cardiac arrest is rare but often catastrophic. The use of extracorporeal cardiopulmonary resuscitation (ECPR) with veno-arterial extracorporeal membrane oxygenation in perioperative settings remains limited. This study evaluated the characteristics and outcomes of patients who underwent ECPR for perioperative cardiac arrest.

This retrospective cohort study used data from the Japanese Intensive Care PAtient Database, a nationwide registry of 129 intensive care units (ICUs), covering fiscal years 2015 to 2023. Adults undergoing noncardiac surgery who experienced cardiac arrest before ICU admission were included. Patients were classified as ECPR if veno-arterial extracorporeal membrane oxygenation was documented. The primary outcome was in-hospital mortality. Secondary outcomes were discharge to home, transfer to another facility, ICU mortality, length of hospital stay, and length of ICU stay. Multivariable logistic regression, adjusted for potential confounders, was used to assess the association between ECPR and in-hospital mortality.

Among 518 patients with perioperative cardiac arrest, 44 (8.5%) received ECPR. The mean age was 66 yr and 62% were male. Patients who received ECPR had higher severity scores, higher lactate levels, and more frequent use of mechanical ventilation and catecholamines than those without ECPR. Unadjusted in-hospital mortality was significantly higher in the ECPR group (61.4 vs. 34.0%; P = 0.001). In the multivariable logistic regression analysis, no statistically significant association was observed between ECPR and in-hospital mortality (odds ratio, 0.85; 95% CI, 0.37 to 1.97).

In this nationwide cohort, ECPR was used in 8.5% of patients with perioperative cardiac arrest in noncardiac surgery. Its effect on in-hospital mortality in the studied population remains inconclusive due to the limited sample size. Further data accumulation is warranted to clarify the clinical role of ECPR in this setting.