Extracorporeal cardiopulmonary resuscitation (ECPR), an emerging resuscitative therapy following refractory cardiac arrests, is associated with hemorrhagic complications that potentially affect patient outcomes.

This study evaluated the risks and predictors of hemorrhagic complications among patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA) from different causes.

Using the SAVE-J II (Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan) study, we analyzed multicentric data of patients who underwent ECPR for OHCA from 2013 to 2018 in Japan. Based on the causes of OHCA, the participants were stratified into endogenous cardiac, endogenous noncardiac, and exogenous groups. The primary outcome was any bleeding.

Among 1,935 patients, 1,417, 305, and 213 patients had endogenous cardiac, endogenous noncardiac, and exogenous causes, respectively. For survivors, the median follow-up period was 36 days, and most of the bleeding events occurred within 1 week post-ECPR. The 30-day cumulative incidence of any bleeding significantly differed among the 3 groups (endogenous cardiac: n = 321 [25.9%]; endogenous noncardiac: n = 41 [18.9%]; and exogenous: n = 27 [13.7%]; P < 0.001). However, the risks for bleeding complications did not differ between the causes of OHCA after adjustment for confounders. Intra-aortic balloon pumping use was associated with higher risks of bleedings and lower risk for all-cause death.

Underlying causes of OHCA did not significantly impact adjusted bleeding risks. Intra-aortic balloon pumping use was independently associated with higher bleeding risks and lower mortality, although this warrants cautious interpretation because of a potential selection bias. Vigilant monitoring for bleeding complications is crucial in ECPR patients, especially in those with additional circulatory support devices.