24, 20, 77
The largest single output of a mature ECPR programme is organs, not survivors, and a survival rate describes a minority of the people the work reaches. Critically, the selection criteria that improve survival roughly halve the donation yield - so the dial described in Chapter 20 has a second, uncounted output. The yield belongs in the programme's annual accounting and must be kept structurally separate from every bedside decision.
Survival with favourable neurological outcome alone
DOI 10.1016/j.resuscitation.2024.110214
ECPR programme, with organ donation counted as an outcome alongside survival
Single centre, retrospective, one national donation framework; the counterfactual for the excluded patients is not observed. Structured abstract only. [VERIFICATION REQUIRED]
256 (83%) died in hospital, 33% from brain death. 58 patients (19%) donated at least one solid organ - 53 (17%) after brain death and 5 (1.6%) after circulatory death - contributing 167 solid organs, median 3.0 (IQR 2.5-4.0) per donor. 29 patients survived with a favourable neurological outcome; 196 individuals possibly benefited in total. The composite of good-neurology survival OR donation of at least one organ was reached by 87 (28%). Solid organ donation fell from 19% to 16% restricting to low-flow under 60 minutes, and to 11% restricting further to an initial shockable rhythm.
307 adults with refractory out-of-hospital arrest treated with ECPR at one metropolitan cardiac arrest centre, 2013-2022; 95% witnessed, 66% shockable, median low-flow 70 minutes (IQR 58-81)