Despite advancements in the area of resuscitation, survival rates in patients treated with conventional cardiopulmonary resuscitation (C-CPR) are still poor, and many survivors suffer from long-lasting brain impairment.1 Extracorporeal cardiopulmonary resuscitation (ECPR) may improve long-term survival by maintaining sufficient oxygenated blood flow to end organs up until an efficient cardiac output has been reestablished, thereby avoiding organ failure. Additionally, ECPR could provide a longer time frame for diagnostic procedures like coronary angiography and subsequent percutaneous coronary intervention. It aims to assist end organ perfusion while possibly reversible problems are addressed.

It is unclear if the increased use of ECPR is causing a rise in the proportion of survivors following cardiac arrest. When comparing to C-CPR, observational studies found that ECPR may have better neurological and survival results for individuals with out-of-hospital cardiac arrest (OHCA).2, 3, 4, 5 A recent meta-analysis further verified the relatively poor results of C-CPR alone in this particular cohort of patients with OHCA.6 In contrast, it was also reported that ECPR did not result in a better outcome when compared to conventional CPR in OHCA.7

According to the latest guidelines, data remain inadequate for recommending regular ECPR for cardiac arrest patients. It was encouraged to be used as a rescue treatment for certain patients with treatable etiologies when traditional CPR attempts fail or to facilitate certain interventions (eg coronary angiography and percutaneous coronary intervention (PCI), pulmonary thrombectomy for massive pulmonary embolism, and rewarming after hypothermic cardiac arrest) in circumstances where it may be quickly deployed and supported by trained professionals.8,9 The variability of indications criteria for ECPR used in the studies might explain the differences in the outcomes. Patients that may be great candidates for ECPR are those who have a cardiac arrest with an initially shockable rhythm, a witnessed arrest with prompt CPR, a lack of sustained return of spontaneous circulation (ROSC) within 10-15 minutes of advanced life support, and are at younger age.10 Patients over 65 years of age are less likely to receive interventions that could improve and extend their quality of life.11 However, the age restriction might be considered on a case-by-case basis.12 Finding ECPR-related prognostic variables may aid physicians in predicting clinical outcomes and increasing the effectiveness of ECPR administration.

In terms of population ethnic and demographic characteristics, Qatar culture and the Middle-East in general is significantly different from previously reported literature. At our center (Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar), it was reported the ECMO patient survival to hospital discharge was 68%.13 Majority of those cases were respiratory failure cases, with 25% were trauma cases. In this study, we aim to evaluate the outcomes (survival rate as well as neurological and disability outcomes) of patients treated with ECPR following in- and out-of-hospital cardiac arrest.