To determine which characteristics are associated with favourable neurological recovery among adults receiving extracorporeal cardiopulmonary resuscitation (ECPR) following out-of-hospital cardiac arrest (OHCA). This retrospective observational investigation drew on a secondary assessment of the SAVE-J II registry, incorporating information from 36 Japanese hospitals. Between 2013 and 2018, the registry documented 2157 OHCA patients treated with ECPR; 1823 fulfilled the criteria for inclusion. Adults aged ≥18 years who underwent ECPR prior to intensive care unit admission were analysed. The principal endpoint was neurological status at discharge, defined by a Cerebral Performance Category score of 1 or 2. Multivariate logistic regression was applied to explore how scene-level or arrival-time variables related to favourable outcomes. Multivariable modelling demonstrated that a shockable rhythm encountered at the scene [odds ratio (OR) 2.11; 95% confidence interval (CI) 1.16–3.95] and upon arrival (OR 2.59; 95% CI 1.60–4.30), CPR delivered by a bystander (OR 1.63; 95% CI 1.03–1.88), body movement during resuscitation (OR 7.10; 95% CI 1.79–32.90), gasping (OR 4.33; 95% CI 2.57–7.28), reactive pupils at arrival (OR 2.93; 95% CI 1.73–4.95), and male sex (OR 0.43; 95% CI 0.24–0.75) were significantly associated with neurological outcome. Shockable rhythm, intervention by a bystander, movement detected during resuscitation, gasping activity, pupillary responsiveness, and sex all showed associations with favourable neurological recovery in OHCA patients managed with ECPR.
