Impact of Transient Return of Spontaneous Circulation and Downtime on Neurological Outcomes following Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Study

Background Despite recent advancements in cardiopulmonary resuscitation (CPR), the prognosis of out-of-hospital cardiac arrest (OHCA) remains poor. Extracorporeal CPR (ECPR) offers potential benefits for patients with refractory OHCA. Identifying the factors associated with neurological outcomes at 180 days and their interactions remains critical for optimizing patient selection. Methods This single-center retrospective study included 65 patients with OHCA treated with ECPR at Kurume University Hospital between 2016 and 2023. Factors associated with the neurological outcomes at 180 days were evaluated using logistic regression and decision tree analyses. Results Favorable neurological outcomes at 180 days were recorded in 18 (27.7%) patients. Transient return of spontaneous circulation (ROSC) (odds ratio (OR): 6.25, 95% confidence interval (CI): 1.82–24.82) and shorter downtime (OR: 0.94, 95% CI: 0.89–0.98) were independently associated with favorable neurological outcomes. Decision tree analysis revealed that the presence of transient ROSC and bystander CPR are upstream factors associated with favorable neurological outcomes, and that the absence of transient ROSC with prolonged downtime was associated with poor outcomes. Conclusion Transient ROSC and shorter downtime were independently associated with favorable neurological outcomes at 180 days in patients treated with ECPR. Using a decision-tree model, we visualized how these key factors interact to influence long-term neurological recovery, highlighting their potential importance in refining the patient selection process for ECPR. Trial registration Not applicable.