Patient and Institutional Characteristics Influence the Decision to Use Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest

BACKGROUND Outcomes from extracorporeal cardiopulmonary resuscitation (ECPR) are felt to be influenced by selective use, but the characteristics of those receiving ECPR are undefined. We demonstrate the relationship between individual patient and hospital characteristics and the probability of ECPR use. METHODS AND RESULTS We performed an observational analysis of adult inpatient cardiac arrests in the United States from 2000 to 2018 reported to the American Heart Association's Get With The Guidelines-Resuscitation registry restricted to hospitals that provided ECPR. We calculated case mix adjusted relative risk (RR) of receiving ECPR for individual characteristics. From 2000 to 2018, 129 736 patients had a cardiac arrest (128 654 conventional cardiopulmonary resuscitation and 1082 ECPR) in 224 hospitals that offered ECPR. ECPR use was associated with younger age (RR, 1.5 for CI, 1.2-1.8), no pre-existing comorbidities (RR, 1.4; 95% CI, 1.1-1.8) or cardiac-specific comorbidities (congestive heart failure [RR, 1.3; 95% CI, 1.2-1.5], prior myocardial infarction [RR, 1.4; 95% CI, 1.2-1.6], or current myocardial infarction [RR, 1.5; 95% CI, 1.3-1.8]), and in locations of procedural areas at the times of cardiac arrest (RR, 12.0; 95% CI, 9.5-15.1). ECPR decreased after hours (3-11 pm [RR, 0.8; 95% CI, 0.7-1.0] and 11 pm-7 am [RR, 0.6; 95% CI, 0.5-0.7]) and on weekends (RR, 0.7; 95% CI, 0.6-0.9). CONCLUSIONS Less than 1% of in-hospital cardiac arrest patients are treated with ECPR. ECPR use is influenced by patient age, comorbidities, and hospital system factors. Randomized controlled trials are needed to better define the patients in whom ECPR may provide a benefit.