PP17 The variability in patient selection criteria across extracorporeal cardiopulmonary resuscitation (ECPR) systems: a systematic review

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered when conventional resuscitation strategies have failed achieving sustained return of spontaneous circulation. To date, there are no universally accepted criteria for patient selection for ECPR. We conducted a systematic review to describe the variability in patient eligibility criteria for ECPR across systems. The review was registered with PROSPERO (registration number: CRD42023451109).

Methods

We searched Cochrane library, Ovid EMBASE, and Ovid MEDLINE databases from inception to 5th February 2024 for all studies where the eligibility criteria for an ECPR system was described. A combination of predetermined search terms was used to identify relevant articles. We conducted forward and backward citation tracking to identify any further relevant articles.

Results

Our search identified 12,503 articles of which 167 articles were found to be potentially eligible. Seventy-seven articles were further excluded as they described the same ECPR system as another study. We included 90 studies in this review. The eligibility criteria for ECPR differed among the included systems. The most frequent criteria used for ECPR eligibility were age (n=75, 81%), arrest witnessed status (n=64, 68.8%), initial rhythm (n=47, 50.5%), and bystander CPR (n=33, 35.5%). Within criteria, we observed marked variability with the most common age cut-offs being 75 years (n=24, 26%), 70 years (n=18, 19%), and 65 years (n=16, 17%). We also noticed differences in the initial rhythm with most systems used shockable rhythm (pVT and/or VF) in their criteria (n=28, 30.1%) than (non-)shockable rhythm (n=19, 20.4%). None of the ECPR criteria reported in studies matched the recently published AHA statement criteria.

Conclusion

Our systematic review showed marked variability across systems in the eligibility criteria for potential ECPR patients. Further studies are needed to determine a unified and optimal eligibility criteria for the implementation of ECPR.