Outcomes among patients with out-of-hospital cardiac arrest who activated an ECPR pathway and achieved ROSC before cannulation.

INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death worldwide, with low survival and poor neurological outcomes despite advances in resuscitation care. The Minnesota Mobile Resuscitation Consortium (MMRC) is a metropolitan-wide hub-and-spoke extracorporeal cardiopulmonary resuscitation (ECPR) program that directs selected patients with OHCA to expert Cannulation Hospitals. Whether patients who achieve prehospital return of spontaneous circulation (ROSC) also benefit from care within such a system remains unknown. METHODS: We conducted a retrospective descriptive study of patients with OHCA meeting entry criteria for the MMRC protocol but achieving prehospital ROSC and transported to three expert ECMO centers between September 2020 and December 2025. Patients with cardiac arrest in the emergency department or the catheterization laboratory as well as patients with missing survival data were excluded. The primary and secondary outcomes were survival to hospital discharge and functionally favorable survival (CPC 1 or 2). RESULTS: Ninety-four patients met inclusion criteria in the MMRC cohort. Patients were predominantly male (73.4%) and mean age was 55.5 years. Seventy-nine patients (84%, 95% CI: 75-90.8) survived to hospital discharge and 70 (74.5%, 95% CI: 64.4-82.9) had a CPC score of 1 or 2 at hospital discharge. At 90 and 180 days, 61 and 54 patients, respectively, had a CPC score of 1 or 2. Only five patients underwent secondary cannulation for ECMO, of whom three survived to hospital discharge. CONCLUSION: Patients with OHCA who achieved prehospital ROSC and were treated within a metropolitan hub-and-spoke ECPR system had an 84% survival rate to hospital discharge, with 74.45% achieving favorable neurological outcome (CPC 1-2), despite infrequent subsequent ECMO use.