RESCUE-IHCA Score for ECPR in In-Hospital Cardiac Arrest
Predicts favourable neurological outcome (CPC 1-2) after ECPR (extracorporeal CPR using VA-ECMO) for refractory in-hospital cardiac arrest. Helps guide appropriate patient selection for this resource-intensive intervention.
Score interpretation
RESCUE-IHCA 0-6 -- low likelihood of neurologically favourable survival with ECPR
→ Carefully weigh ECPR benefit vs resource use and procedural risk; multidisciplinary team decision with senior cardiologist/intensivist; consider patient advance directives and known wishes; time-limited trial of ECPR may be discussed if family/patient preference; continue conventional ALS; if ECPR not pursued: ongoing high-quality CPR and treat reversible causes (4Hs and 4Ts); DNACPR documentation after failed resuscitation attempt; family support.
RESCUE-IHCA 7-12 -- moderate probability; ECPR consideration with team discussion
→ Senior cardiologist and intensivist review immediately; if ECPR team available and patient criteria met (refractory VF/PEA, good CPR quality, < 60 minutes CPR duration): cannulate for VA-ECMO; mobilise ECPR team; femoral arterial and venous cannulation (percutaneous or cutdown); target flow 2.5-3.0 L/min; coronary angiography immediately if cardiac cause suspected; post-resuscitation care: targeted temperature management (32-36 degrees C for 24 hours), haemodynamic targets, pupillary and EEG monitoring; neurological prognostication at >= 72 hours; early neurorehabilitation if recovery.
RESCUE-IHCA 13-19 -- high likelihood of neurologically favourable survival; ECPR strongly indicated
→ Immediate ECPR if team available and patient eligible; activate ECPR protocol now; cannulation target < 5 minutes from decision; VA-ECMO settings: flows 3.0 L/min, ramp up to target MAP > 65 mmHg; IABP or LV vent addition if LV distension (visible aortic valve non-opening on echo); proceed to coronary angiography; targeted temperature management and ICU monitoring; daily neurological assessment; EEG for subclinical seizures; MRI brain at 48-72 hours to assess neurological injury; neurorehabilitation pathway early; family communication with cautiously optimistic prognosis.
Interpretation bands for the RESCUE-IHCA. Apply clinical judgement and local guidance.
References
- Yeo HJ et al. Development and validation of the RESCUE-IHCA score for predicting survival after ECPR in in-hospital cardiac arrest. Resuscitation. 2021;168:53-59.
- Panchal AR et al. 2019 American Heart Association focused update on advanced cardiovascular life support. Circulation. 2019;140(24):e881-e894.
Related
Curated clinical cross-links plus same-class fallbacks.
- Lipid Emulsion 20% (Intralipid) · Antidote / Resuscitation
- Amiodarone (IV — ICU/Peri-Arrest) · Antiarrhythmic (Class III)
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Ranolazine · Refractory Stable Angina
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Mavacamten · Cardiac myosin inhibitor
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.