Background

Extracorporeal cardiopulmonary resuscitation (ECPR) is a time-critical intervention for selected patients with refractory cardiac arrest. Survival depends on minimizing low-flow duration before ECPR initiation. Timely deployment requires organizational preparedness, trained personnel, and rapid extracorporeal membrane oxygenation (ECMO) circuit readiness. However, data on ECPR organization in centers operating without dedicated perfusionist support are limited.

Methods

A nationwide cross-sectional online survey was conducted among German ECMO centers operating without perfusionist support. The questionnaire assessed circuit readiness, responsible personnel, training frequency, and the availability of standard operating procedures (SOPs).

Results

Responses from 42 centers were evaluated, of which 64% reported performing ECPR (n = 27). Most centers (90%, n = 38) had low annual ECMO volumes (< 50 cases). ECMO use was largely limited to the Cardiohelp and iLA activve/Xenios Console systems. Setup times were significantly shorter for ECPR than for non-ECPR ECMO: median 15 min (IQR 12–18; range 5–30) versus 30 min (IQR 20–40; range 15–105) (Mann–Whitney U = 46, p < 0.0001; Cliff’s delta = 0.77; 95% CI 0.54–0.94). Nurses were more frequently involved in ECMO deployment in ECPR than in non-ECPR settings (59% (16/27 centers) vs. 20% (3/15 centers)). Within ECPR programs, regular training was reported more frequently for nurses than for physicians (87.5% (14/16 centers) vs. 60% (6/10 centers)). Overall, 76% (n = 32) of centers reported regular training (at least annually) for responsible personnel, 86% (n = 36) had internal SOPs in place, and 69% (n = 29) expressed the need for a universally applicable evidence-based SOP. All centers that reported a pre-defined maximum storage duration (n = 28) adhered to the Extracorporeal Life Support Organization guidelines regarding maximum storage duration of pre-assembled ECMO systems (30 days).

Conclusions

German ECMO centers without perfusionist support reported substantial heterogeneity in ECPR readiness and operational workflows. ECPR-performing centers were associated with shorter setup times and more frequently reported interdisciplinary team structures and recurrent team training. These findings describe current organizational practices and perceived needs and support the value of interdisciplinary teamwork, structured training, and standardized protocols as organizational components that may facilitate timely, standardized ECPR deployment.