Long-term heart function in refractory out-of-hospital cardiac arrest treated with prehospital extracorporeal cardiopulmonary resuscitation

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.

Methods: We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.

Results: A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1-1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6-8.0) years. Half of these patients were actively working, with a median time of 10 months (3-21) to regain the ability to work since the onset of OHCA.

Conclusion: Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.