Does Percutaneous Coronary Intervention Improve Survival for Out-Of-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation?

ABSTRACT Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) can support patients who fail to respond to standard resuscitation for out-of-hospital cardiac arrest (OHCA) allowing further time for critical interventions and patient recovery. Although the majority of patients with refractory OHCA have coronary artery disease, the role of emergent percutaneous coronary intervention (PCI) is not clear. We evaluated the effect of PCI on survival to hospital discharge (SHD) in a contemporary cohort of patients with OHCA receiving ECPR. Methods We performed a retrospective study using data from the Extracorporeal Life Support Organization (ELSO) registry. We included patients ≥18 years with OHCA due to a presumed cardiac etiology or an initial shockable rhythm who received ECPR from January 2020 to December 2023. Our primary outcome was SHD. We used inverse probability weighted matching to estimate the average treatment effect of PCI on SHD. We also performed a sensitivity analysis of patients most likely to benefit from PCI (witnessed arrest and no return of spontaneous circulation after five minutes of cardiopulmonary resuscitation. Results Of 1336 OHCA patients receiving ECPR, 1131 were included in the final analysis after exclusions for age (n=31) and presumed non-cardiac or initial non-shockable rhythm (n=174). The median age was 55 years (IQR 44-62) and most patients were male (n=901, 80%). Twenty-one percent (n=243) received PCI; those patients who received PCI were slightly older (58 [IQR 48-63] vs 53 [IQR 42-62]) and more often male (n=212 [87%] vs n=689 [78%]). In the primary analysis, we found no significant difference in SHD for patients who received PCI compared to those who did not receive PCI (–3.56%, 95% CI –10.31 to 3.19; p-value 0.301). In our sensitivity analysis, we also did not find a significant difference in SHD for patients who received PCI compared to those who did not receive PCI (–4.52%, 95% CI – 12.42 to 2.46; p-value 0.246). Conclusion In our registry-based study of refractory OHCA patients receiving ECPR, emergent PCI was not associated with a significant improvement in SHD. CLINICAL PERSPECTIVE What Is New? This is the largest cohort to date of patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation and percutaneous coronary intervention; this study evaluates the effect of percutaneous coronary intervention on survival to hospital discharge. 2) What Are the Clinical Implications? The lack of improvement in survival suggests that additional prospective studies evaluating the timing of percutaneous coronary intervention are needed to further clarify its role within the extracorporeal cardiopulmonary resuscitation care pathway.