# The influence of preexisting coronary artery disease on long-term follow up and neurological outcome in patients receiving out of hospital extracorporeal membrane oxygenation

## TL;DR

This study examines how preexisting coronary artery disease affects survival and neurological outcomes in patients receiving out-of-hospital extracorporeal membrane oxygenation.

## Contribution

The study identifies factors influencing survival and neurological outcomes in ECPR patients, emphasizing the role of coronary artery disease and initial heart rhythm.

## Key findings

- 44.8% of patients survived to discharge, with long-term survival rates influenced by shockable rhythm and absence of coronary artery disease.
- Survivors had excellent neurological outcomes with a CPC score of 1, especially those without coronary artery disease and with shockable rhythm.
- Older age and longer pre-ECMO resuscitation duration worsened neurological outcomes.

## Abstract

Pre-hospital extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest is costly and resource-intensive. Low survival rates raise questions concerning efficacy of ECPR. We aimed to analyze survival and neurological outcome of these patients and the influence of underlying coronary artery disease as well as shockable heart rhythm leading to resuscitation.

Retrospective analysis of our ECMO database revealed 94 patients receiving ECPR for out-of-hospital cardiac arrest from September 2009 to May 2023. After exclusion of patients with pulmonary embolism, drowning or intoxication as confounders, 58 patients remained. Patients were divided into 2 groups depending on underlying coronary artery disease and initial heart rhythm. Primary outcome was survival to discharge and long-term survival, secondary outcome was neurological capacity analyzed with the cerebral performance category score (CPC).

26 patients (44.8 %) survived to discharge; 6 patients died during a median follow-up time of 1057.5 days. There was no significant difference concerning survival to discharge between the groups. Numerically, more patients with shockable rhythm and without coronary artery disease survived. Kaplan-Meier analysis revealed a survival benefit for patients with shockable rhythm without coronary artery disease (p < 0.007). 92.3 % of survivors had a CPC-Score of 1. CPC Score did not differ between the groups.

Though mortality in ECPR patients remains high with 55.2 %, long-term and neurological outcome with a CPC score of 1 is very good, especially of those with shockable rhythm and without coronary artery disease. Old age and duration of cardiopulmonary resuscitation pre-ECMO impair neurological outcome. Thus, on-site ECMO cannulation should be endorsed.