Among 1,131 out-of-hospital cardiac arrest patients supported by extracorporeal CPR (ECPR) and drawn from the international ELSO registry (2020–2023), emergent percutaneous coronary intervention (PCI) conferred no statistically significant survival advantage. The absolute difference in survival to hospital discharge was just -3.56% (95% CI -10.31 to 3.19; p=0.301) favoring the non-PCI group, a null result that held even in a sensitivity analysis restricted to witnessed arrests with prolonged resuscitation — the subgroup considered most likely to benefit from rapid coronary revascularization.
This finding lands in a contentious space. The landmark ARREST trial suggested ECPR itself dramatically improves outcomes versus standard care, yet the additive role of PCI has remained poorly defined. Most refractory cardiac arrest patients carry significant coronary artery disease, creating a clinical intuition — now challenged here — that opening blocked arteries during ECMO support should logically help. This retrospective, registry-based analysis cannot establish causation: unmeasured confounders, selection bias in who received PCI, and heterogeneous operator protocols across ELSO sites all limit interpretation. The cohort skews heavily male (80%), potentially constraining generalizability. Critically, this is a preprint posted on medRxiv and has not yet been peer-reviewed — findings and effect estimates may shift after scrutiny. Still, the consistency across both primary and sensitivity analyses makes this more than incremental. Clinicians weighing the risk-benefit calculus of adding emergent PCI to an already complex ECPR intervention now have meaningful — if not definitive — registry-scale evidence urging caution.
