Landscape of Extracorporeal Cardiopulmonary Resuscitation in Germany. A Nationwide Retrospective Study

Sudden cardiac death is a leading cause of death globally. Recent guidelines recommend considering extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest, but evidence regarding favorable outcomes remains scarce.

This nationwide retrospective observational study analyzes ECPR for out-of-hospital cardiac arrest (OHCA) in Germany. The Federal Statistical Office of Germany provided data for all refractory OHCA patients in German hospitals between 2018 and 2023, including identification of those who received ECPR. All patients aged 18 years and older were included. The primary endpoint was hospital mortality. Secondary endpoints were center caseload and location.

Between 2018 and 2023 27,056 patients were admitted with OHCA refractory to conventional CPR and 785 (2.9%) received ECPR. Survival without ECPR was 11.3% and 11.8% with ECPR, with no significant difference between the groups. ECPR utilization increased from 1.8% (n = 62) in 2018 to 4.1% (n = 168) in 2023, but survival rates remained unchanged. Among hospitals treating patients with OHCA, 11.6% (n = 102) provided ECPR. The median number of annual cases per ECPR center was three. Urban centers had higher prior VA ECMO experience and ECPR caseload. Survival was higher for urban centers, though not statistically significant.

Between 2018 and 2023, ECPR was used for 2.9% of refractory OHCA cases admitted to hospitals in Germany. ECPR utilization increased while survival remained unchanged at approximately 12%. The widespread provision of ECPR by institutions with low case volume, within the specific regulatory and organizational context of the German health care system, underscores the need for national quality standards and registries to improve consistency of ECPR care.