Quality improvement in the administration of extracorporeal cardiopulmonary resuscitation (ECPR)\nover time and its association with low-flow duration (LFD) and outcomes of cardiac arrest (CA) have been\ninsufficiently investigated. In this study, we hypothesized that quality improvement in efforts to shorten the\nduration of initiating ECPR had decreased LFD over the last 15 years of experience at an academic tertiary care\nhospital, which in turn improved the outcomes of in-hospital CA (IHCA).\nMethods: This was a single-center retrospective observational study of ECPR patients between January 2003 and\nDecember 2017. A rapid response system (RRS) and an extracorporeal membrane oxygenation (ECMO) program\nwere initiated in 2011 and 2013. First, the association of LFD per minute with the 90-day mortality and neurological\noutcome was analyzed using multiple logistic regression analysis. Then, the temporal changes in LFD were\ninvestigated.\nResults: Of 175 study subjects who received ECPR, 117 had IHCA. In the multivariate logistic regression, IHCA\npatients with shorter LFD experienced significantly increased 90-day survival and favorable neurological outcomes............
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