Post-resuscitation care after adult extracorporeal cardiopulmonary resuscitation: A scoping review.

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used in adults with refractory cardiac arrest. However, post-resuscitation care in this population remains heterogeneous, evidence-based recommendations are lacking, and most evidence is derived from conventional cardiopulmonary resuscitation. We conducted a scoping review to describe the existing evidence on post-resuscitation care after ECPR. We systematically searched PubMed and Embase from inception to May 19, 2025, for studies reporting on post-resuscitation care in adults treated with ECPR following out-of-hospital or in-hospital cardiac arrest. Findings were extracted and summarized in a narrative format. A total of 133 studies published between 2015 and 2025 were included. The most frequently investigated domains included hemodynamic monitoring and management (30/133, 23 %), neurological monitoring and prognostication (22/133, 17 %), oxygenation, carbon dioxide, and ventilation (18/133, 14 %), complications other than bleeding (15/133, 11 %), and coagulation/bleeding (13/133, 9.8 %). Other domains included long-term outcomes (8/133, 6.0 %), temperature control (8/133, 6.0 %), imaging (7/133, 5.3 %), organ donation (5/133, 3.8 %), and general intensive care management (5/133, 3.8 %). While select studies reported associations between specific exposures or interventions and clinical outcomes, the level of evidence was limited by small sample sizes (only 22/133 [17 %] included >500 patients), study design (119/133 [90 %] were retrospective), and inconsistent outcome reporting. Post-resuscitation care after adult ECPR remains poorly characterized and insufficiently studied. Available evidence across all domains is constrained by heterogeneity, retrospective designs, and small sample sizes. Prospective, well-designed studies are needed to generate robust evidence to guide clinical decision-making and define ECPR-specific post-resuscitation strategies.