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ORIGINAL RESEARCH article

Front. Med.

Sec. Intensive Care Medicine and Anesthesiology

Long-term neurological outcome following out-of-hospital cardiac arrest (OHCA) in Switzerland: a single-centre observational study

Provisionally accepted
Federico EbertFederico Ebert1Mirjam AbtMirjam Abt2Tobias FehrTobias Fehr3Katharina SeidlKatharina Seidl4Markus HuberMarkus Huber1Roger LudwigRoger Ludwig5,6,7Manuela ItenManuela Iten5,6,7Robert GreifRobert Greif6,8Sabine NabeckerSabine Nabecker9Alexander FuchsAlexander Fuchs1,6*
  • 1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  • 2Department of Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland
  • 3Department of Intensive Care Medicine, Lindenhofspital, Bern, Switzerland
  • 4Schutz & Rettung Bern (SRB), Bern, Switzerland
  • 5Inselspital Universitatsspital Bern Universitatsklinik fur Intensivmedizin, Bern, Switzerland
  • 6Universitat Bern, Bern, Switzerland
  • 7University Hospital of Bern, Bern, Switzerland
  • 8Faculty of Medicine, University of Bern, Bern, Switzerland
  • 9Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada

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Background: Favourable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) vary across countries. Different advanced resuscitation strategies such as extracorporeal cardiopulmonary resuscitation (ECPR) might have impact on long-term neurological outcome. However, this remains unclear in Switzerland. Methods: This retrospective single-centre observational study included all patients with OHCA transported by the local emergency medical services to a large Swiss academic hospital between 1 January 2015 and 31 December 2023. Data were collected before and after the implementation of the local ECPR programme for patients with refractory OHCA on 01 May 2018. The primary outcome was one-year favourable neurological outcome, defined as Cerebral Performance Categories 1 and 2. Secondary outcomes included 30-day favourable neurological outcome, characteristics and survival of patients treated with ECPR, and factors associated with non-survival among all OHCA patients. Results: A total of 578 patients with OHCA were transported to the hospital. Favourable neurological survival at 1 year was 16.8%(95%-CI:12.1%-22.4%) before and 21.5%(95%-CI:17.4%-26.1%) after the ECPR programme implementation. Hazard ratios for overall survival were 2.19 for patients with a non-shockable initial rhythm, 1.02 for older age and 1.68 for unwitnessed OHCA. Of all transported patients, 16.8% (n=97, n=31 before vs. n=66 after) met local ECPR criteria. In total 34 patients with refractory OHCA were treated with ECPR, all assessable survivors had favourable 1-year neurological outcomes. Conclusion: This observational study on patients sustaining OHCA transferred to a large Swiss hospital showed 1y favourable outcome in 19.7% (95%-CI: 16.6% to 23.2%). Among ECPR patients, all five survivors had a favourable neurological outcome at 1y. No association was found between implementing an ECPR programme for patients with refractory OHCA and 1y favourable neurological outcome. However, the effect might be underestimated given the low incidence of ECPR. Clinical trial number: NCT03759210

Keywords: ECPR, neurological outcome, OHCA, Out-of-Hospital Cardiac Arrest, Survival

Received: 30 Sep 2025; Accepted: 30 Nov 2025.

Copyright: © 2025 Ebert, Abt, Fehr, Seidl, Huber, Ludwig, Iten, Greif, Nabecker and Fuchs. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Alexander Fuchs

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Supplementary Material