• Yoonjic Kim, Jeong Ho Park, Sun Young Lee, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, and Sang Do Shin.
• Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: ambition86.kim@gmail.com.
• Am J Emerg Med. 2022 Nov 24; 64: 142149142-149.

IntroductionThe best location for safe and timely implementation of extracorporeal cardiopulmonary resuscitation (ECPR) is currently uncertain. We aimed to evaluate the association between the location of ECPR and survival outcomes in out-of-hospital cardiac arrest (OHCA) patients. We also evaluated whether the effects of ECPR location on survival differed between patients who underwent coronary angiography (CAG) and those who did not.MethodsWe used data collected between 2013 and 2020 from a nationwide OHCA database. Adult OHCA patients with presumed cardiac etiology who underwent ECPR were included in the study. The primary outcome was survival to discharge. The main exposure was the ECPR location (emergency department [ED] or cardiac catheterization laboratory [Cath lab]). We compared primary outcomes of ECPR between the ED and Cath lab using multivariable logistic regression. The interaction between ECPR location and CAG was also evaluated.ResultsOf 564 ECPR patients, 448 (79.4%) and 116 (20.6%) underwent ECPR in the ED and Cath lab, respectively. CAG was observed in 52.5% and 72.4% of the patients in the ED and Cath lab groups, respectively. There were no significant differences in survival to discharge between the ED and Cath lab groups (14.1% vs. 12.9%, p = 0.75, adjusted odds ratio [AOR] [95% confidence interval] 1.87 [0.85-4.11]). AOR of interaction analysis (95% CI) for survival to discharge of the ED group was 2.34 (1.02-5.40) in patients with CAG and 0.28 (0.04-1.84) in patients without CAG (p for interaction was 0.04).ConclusionIn adult OHCA patients who underwent ECPR and CAG, ECPR in the ED shortened time to ECMO pump-on time and increased survival to discharge compared to ECPR in the Cath lab.Copyright © 2022 Elsevier Inc. All rights reserved.

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