ECPR Achieves Up to 43 Percent Survival in Refractory Cardiac Arrest, Review Outlines Roadmap for India

Refractory cardiac arrest presents high mortality despite advanced cardiac life support (ACLS), yet while international trials of venoarterial extracorporeal membrane oxygenation (ECMO) report up to 43% survival by maintaining organ perfusion, significant infrastructural and resource deficits have created a critical clinical gap regarding its real-world application in India. To bridge this gap, Dr. Tapas K Sahoo from Medanta Hospital, Ranchi, Dr. Mohit Katare from National University Hospital, Singapore, and their multicenter team conducted this study to evaluate national feasibility, identify systemic obstacles, and establish a pragmatic roadmap for integrating advanced resuscitation protocols into Indian healthcare.

Therefore, the narrative review evaluated literature from 2000 to 2026 across PubMed, Scopus, and Google Scholar to compare conventional cardiopulmonary resuscitation with ECPR across adult, pediatric, and neonatal populations. It assessed survival to hospital discharge, favorable neurological recovery, and implementation feasibility within resource-limited settings.

Key Clinical Findings of the Review Include:

• Global Survival Advantage: Review demonstrates superior survival to hospital discharge with extracorporeal life support reaching 30% in adults (7,718/25,728) and 42% in neonates (1,332/3,173) globally, compared to regional survival rates of 22% in adults and 44% in neonates across South West Asia and Africa.
• International Trial Superiority: Analysis highlights marked neurological and survival benefits in clinical trials such as Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation, where ECPR achieved 43% survival (6/14) versus 7% (1/15) with standard therapy, and Prague Out-of-Hospital Cardiac Arrest with 31.5% versus 22.0% six-month survival.
• Severe Bystander and Transport Gaps: Review reveals critical prehospital limitations in India, including bystander cardiopulmonary resuscitation (CPR) rates below 1.3%, general CPR awareness at only 2%, and paramedics present in just 34% of hospital ambulance services.
• Scarcity of Specialized Infrastructure: The report indicates that among approximately 54 active ECMO centers in India, only 20 are formally registered with the Extracorporeal Life Support Organization (ELSO), with inexperienced facilities citing equipment shortages and financial constraints as primary barriers at 50% each.
• Structured Operational Strategy: Authors propose a four-phase implementation framework prioritizing initial in-hospital cardiac arrest (IHCA) cases and high-volume urban hubs to establish standardized protocols before scaling regional hub-and-spoke networks.

The results suggest that while extracorporeal cardiopulmonary resuscitation provides meaningful survival rates up to 42% globally, overcoming local bystander CPR rates of 1.3% through structured in-hospital pathways can establish a viable life-saving intervention across India.

Thus, the review concludes that clinicians may optimize resuscitation outcomes by implementing standardized screening algorithms—targeting patients under 60 years of age with witnessed arrests, shockable initial rhythms, and low-flow durations under 60 minutes—while embedding pre-primed extracorporeal circuits within high-acuity hospital units.

Although the synthesis is constrained by the paucity of prospective multicenter Indian data and reliance on Western clinical literature, establishing a centralized national registry and conducting context-specific trials will provide crucial evidence to refine local practices.

Reference

Sahoo TK, Katare M, Oza P, Nagachandan MS, Guru PK, Gupta V, et al. Extracorporeal Cardiopulmonary Resuscitation in India: Current Feasibility, Challenges, and Roadmap for Implementation. Indian J Crit Care Med 2026;30(9):714–725.