• Amani Alenazi, Mohammed Aljanoubi, Joyce Yeung, Jason Madan, Samantha Johnson, and Keith Couper.
• Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
• Resuscitation. 2024 Nov 1; 204: 110403110403.

BackgroundAcross the world, many systems have implemented extracorporeal cardiopulmonary resuscitation (ECPR) as a potential treatment strategy for patients in refractory cardiac arrest. To date, there are no universally accepted criteria for patient selection for ECPR. We conducted a systematic review to explore the variability in patient eligibility criteria for ECPR across systems.MethodsWe searched the Cochrane Library(Wiley), EMBASE(OVID), and MEDLINE ALL (OVID) databases from inception to 5th February-2024 for all studies that described an ECPR system and where the system eligibility criteria was described. A combination of predetermined search terms was used to identify relevant articles. We conducted forward and backward citation tracking to identify any further relevant articles.ResultsOur search identified 12,503 articles of which 167 articles were found to be potentially eligible. Seventy-seven articles were further excluded as they described the same ECPR system as another study. We finally included 90 studies describing a total of 93 ECPR systems. The eligibility criteria for ECPR differed among the included systems. Across systems, ECPR eligibility criteria included age (n=75, 80.7%), arrest witnessed status (n=64, 68.8%), any initial rhythm (n=55, 59.1%), and bystander CPR (n=33, 35.5%). Within criteria, we observed marked variability. The age cut-off varied from 50 to 80 years, with the most common age cut-off being 75 years and 18 (19.3%) systems having no cut-off. Whilst most systems limited ECPR to shockable rhythms (n=28,30.1%), some systems included shockable rhythms and/or PEA only (n=10,10.8%).ConclusionWe observed marked variability across systems in the eligibility criteria for potential ECPR patients. There is a need for further work to identify the optimum ECPR selection criteria.Review RegistrationPROSPERO (CRD42023451109).Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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