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Cardiac arrest
ECPR timing in refractory OHCA: survival gap persists
Earlier Versus Later Extracorporeal Cardiopulmonary Resuscitation in Refractory Out-of-Hospital Cardiac Arrest: A Nationwide Sequential Landmark Target Trial Emulation
European Heart Journal. Acute Cardiovascular Care · 2026-10-25 · Added 26 October 2026
A target trial emulation in 58,668 patients with refractory OHCA from the Korean nationwide registry found ECPR was associated with higher 30-day survival at 15, 30 and 60 minutes after ED arrival (+15.0, +14.4 and +7.7 percentage points); an exploratory analysis found the benefit narrowed but remained significant to 120 minutes.
- Study type
- Registry
- Design
- Nationwide registry target trial emulation (sequential landmark)
- Participants
- 58,668 patients with refractory OHCA (909 received ECPR)
- Main finding
- Weighted 30-day survival with ECPR vs conventional CPR was 31.0% vs 16.0%, 21.6% vs 7.2% and 10.9% vs 3.2% at 15, 30 and 60 minutes after ED arrival; an exploratory analysis found benefit narrowed but stayed significant to 120 minutes
- Caveat
- Propensity-adjusted observational design, not randomised — residual selection bias about who gets ECMO is likely
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). ECPR is an in-hospital tool — Australian crews don't deliver it — but the refractory-arrest transport and destination decisions that get a patient to an ECMO centre are ours, and the finding questions the 60-minute cut-off many systems apply.
Learning goal
Weigh the benefits and uncertainties of ECPR for refractory cardiac arrest beyond the conventional sixty-minute window.
More
- Topic: Cardiac arrest
- Daily scan: 26 October 2026
- Podcast: Paramedic Papers Daily, 26 October 2026
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