Prehospital Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest

BACKGROUND: In patients with refractory out-of-hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) with the use of venoarterial extracorporeal membrane oxygenation can be performed to establish reperfusion. Data comparing prehospital ECPR with conventional care regarding survival until hospital discharge among patients who are 50 years of age or younger with refractory out-of-hospital cardiac arrest are limited. METHODS: In a nationwide, nonrandomized study conducted in the Netherlands, we evaluated the outcomes in young adults who were attended by Helicopter Emergency Medical Services (HEMS) that were equipped to deliver prehospital ECPR (intervention group) as compared with those attended by HEMS without ECPR capability (conventional group). The primary outcome was survival until hospital discharge. RESULTS: A total of 144 patients were included in the intervention group, and 87 were included in the conventional group. In the intervention group, 57 of 144 patients (40%) survived until hospital discharge, as compared with 17 of 87 patients (20%) in the conventional group (odds ratio, 2.72; 95% confidence interval [CI], 1.59 to 4.66; P = 0.002). At 6 months, a favorable neurologic outcome was reported in 51 of 141 patients (36%) in the intervention group and in 11 of 85 patients (13%) in the conventional group (odds ratio, 4.22; 95% CI, 2.82 to 6.32). There were 32 adverse events in the intervention group and 11 in the conventional group. CONCLUSIONS: Among patients who were 50 years of age or younger with out-of-hospital cardiac arrest, incorporating ECPR into HEMS was associated with improved survival until hospital discharge, as compared with conventional care. (Funded by the Dutch Ministry of Health; OnScene ClinicalTrials.gov number, NCT04620070.).