The effect of initial rhythm on patient outcome in refractory cardiac arrest requiring extracorporeal cardiopulmonary resuscitation: A retrospective, multicentre registry cohort study.

Authors

Wafira Y Wilson, Kerina J Denny, James P A McCullough, Carol L Hodgson, Bentley J Fulcher, James R Winearls

Published in

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine. Volume 28. Issue 3. Pages 100203. Epub Jul 29, 2026.

Abstract

To determine the effect of initial rhythm on 6-month survival with favourable functional outcomes in patients supported with extracorporeal cardio pulmonary resuscitation (ECPR) for in-hospital cardiac arrest and out-of-hospital cardiac arrest (IHCA and OHCA).Design/Setting/Participants: This multicentre cohort study used secondary data from the EXCEL registry, a binational extracorporeal membrane oxygenation (ECMO) database across Australia and New Zealand. Adults receiving ECPR between February 2019 and December 2022 were included.
The primary outcome was 6-month survival with a favourable functional outcome, defined using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 (12-item survey). Secondary outcomes included: survival (intensive care unit [ICU], hospital, 90- and 180-day), duration of ECMO and ventilation, ICU and hospital length of stay, and work status at 6 months.
Among 249 patients, 123 (49.4%) had an initial shockable rhythm and 126 (50.6%) had a nonshockable rhythm. Overall, 16% (40/249) survived with favourable functional outcomes. Rates were higher in the shockable group (21% vs. 11%, p = 0.031), despite the non-shockable group having more witnessed arrests (98 vs. 90%, p = 0.005) and shorter low-flow times (46.8 vs 65.5 min, p = 0.003). Survivors with a nonshockable rhythm had longer ICU (19.8 vs. 12.7 days, p = 0.028) and hospital stays (39.6 vs. 27.0 days, p = 0.003). Unemployment due to health issues at 6 months was similar between the shockable (14/40 [35%]) and nonshockable (12/32 [37.5%]) groups (p = 0.826).
An initial shockable rhythm was associated with higher 6-month survival with favourable functional outcomes after ECPR. Larger studies are needed to confirm whether rhythm-guided selection may improve patient outcomes.

PMID:
42571200
Bibliographic data and abstract were imported from PubMed on 09 Aug 2026.

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