Extracorporeal cardiopulmonary resuscitation following cardiac surgery: a scoping review

TL;DR

This review maps the current evidence on using ECPR after heart surgery in adults and children, highlighting survival rates and key research gaps.

Contribution

First scoping review of ECPR after cardiac surgery, identifying major evidence gaps and variability in outcomes.

Findings

ECPR after cardiac surgery shows 33–35% overall survival in adults and 10–70% in children.

Pediatric ECPR often involves longer chest compressions, with survival rates varying widely.

Few studies address ECPR in minimally invasive or ventricular assist device surgery cases.

Abstract

•First scoping map of post-cardiac-surgery extracorporeal cardiopulmonary resuscitation in adults and children.•Overview of 49 studies capturing outcome ranges in post-cardiac-surgery ECPR.•Major evidence gaps identified: non-sternotomy and ventricular assist device populations.•Marked heterogeneity; protocols/timing need optimization.•Actionable research roadmap to inform trials and guideline updates.

First scoping map of post-cardiac-surgery extracorporeal cardiopulmonary resuscitation in adults and children.

Overview of 49 studies capturing outcome ranges in post-cardiac-surgery ECPR.

Major evidence gaps identified: non-sternotomy and ventricular assist device populations.

Marked heterogeneity; protocols/timing need optimization.

Actionable research roadmap to inform trials and guideline updates.

In-hospital cardiac arrest after cardiac surgery demands specific approaches, such as rapid resternotomy, internal cardiac massage and sequential defibrillation. Extracorporeal cardiopulmonary resuscitation (ECPR) is a viable option; however, it is not standardized. This scoping review summarizes current evidence and identifies knowledge gaps regarding ECPR after cardiac surgery.

We searched PubMed, Web of Science, Cochrane Library, and Ichushi-Web (a Japanese medical database) from July 29, 2024 through March 20, 2025. Studies reporting outcomes in patients received ECPR after cardiac surgery were included, without restrictions on study design or language.

Of 3963 unique articles, 49 studies were included. Among these, 3 adult and 17 pediatric studies reported ≥20 identifiable post–cardiac surgery ECPR cases (91 adult cases and 1464 pediatric cases). Across the included adult literature, only two ventricular assist device cases and no minimally invasive cardiac surgery cases were found. Adult post-cardiac surgery ECPR outcomes showed 33–35 % of overall survival and 23–29 % of survival with favorable neurological outcome. Pediatric outcomes were variable, with 10–70 % of overall survival and 10–40 % survival with favorable neurological outcome. Chest compression duration ranged from 31 to 36 min in adult post-cardiac surgery ECPR and from 27 to 60 min in pediatrics, where this metric was frequently available only from mixed surgical/non-surgical cohorts.

Both adult and pediatric groups demonstrated variable but relatively high overall survival and survival with favorable neurological outcome following ECPR. Pediatric studies highlighted prolonged chest compressions. Further research is needed to explore the role of ECPR following minimally invasive and ventricular assist device surgery.

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