20, 30, 77
The only published head-to-head test of the criteria set that most units' ECPR lists are derived from, and the anchor of Chapter 20 §20.4. An AUC of 0.63 with a lower bound of 0.54 means the standard criteria rank a good-outcome patient above a poor-outcome patient about 63 times in 100. The practical consequence is NOT to abandon the list — it is an operational instrument applicable in ninety seconds, which the Pre-ECPR score is not, since it needs cerebral oximetry and a blood gas — but to hold its individual thresholds loosely and to build in a named senior override route.
The ELSO 'Example of selection criteria for ECPR'
DOI 10.1053/j.jvca.2024.09.009
The Pre-ECPR score — age, a composite of no-flow and initial rhythm, total cardiac arrest time, signs of life, pupil dilation, regional cerebral oxygen saturation, arterial pH and end-tidal CO2
Single centre, 120 patients, development and testing in the same dataset with internal cross-validation only, no external validation, abstract only. Not replicated. Nothing contradicts it and no study has shown the standard criteria performing better.
Pre-ECPR score AUC 0.87 (95% CI 0.77–0.93) in development and 0.79 (0.67–0.88) in internal cross-validation. THE ELSO EXAMPLE SELECTION CRITERIA ACHIEVED AN AUC OF 0.63 (95% CI 0.54–0.72) for 1-year survival with favourable outcome; the difference was significant, P = 0.012. A Pre-ECPR probability above 6.4% gave 100% sensitivity with a positive predictive value of 40.5%.
All 120 normothermic ECPR patients treated at a single Swedish university hospital between January 2010 and October 2021. Favourable outcome (modified Rankin Scale 0–3) occurred in 27.5%.