Patient Selection for eCPR: A Comparative Review of Eligibility Criteria and Their Impact on Survival in OHCA and IHCA Settings

Background Extracorporeal cardiopulmonary resuscitation (eCPR) is an advanced, resource-intensive salvage therapy for refractory cardiac arrest. Despite its potential, survival rates vary significantly due to heterogeneous patient selection criteria between medical centers. The distinction between out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) is particularly critical, as logistical and physiological differences necessitate tailored qualification protocols to ensure both clinical efficacy and rational resource allocation. Aim The aim of this review was to compare eCPR eligibility criteria in OHCA and IHCA settings. The study sought to identify the combination of demographic, temporal, and physiological factors that are most strongly associated with survival and favorable neurological outcomes, thereby providing evidence-based recommendations for optimizing patient selection protocols. Material and methods A comprehensive comparative review of current literature was conducted, including systematic reviews, randomized controlled trials, and registry data. The analysis focused on synthesizing and contrasting established inclusion and exclusion criteria, such as age limits, time-to-ECMO intervals, and initial cardiac rhythms, as applied in both OHCA and IHCA populations. Results The review confirmed that eligibility criteria for OHCA are consistently more restrictive than for IHCA, primarily due to longer unavoidable low-flow times. Key predictors for favorable outcomes across both settings were identified as: age