Among 360 refractory out-of-hospital cardiac arrest patients with coagulation data, unsupervised clustering identified three phenotypes at ECPR initiation: severe consumptive, mild consumptive and preserved coagulation. Survival was 0%, 8.6% and 33.1%, respectively; favourable neurological outcomes occurred in 0%, 5.1% and 17.6%. Compared with preserved coagulation, mild consumptive coagulopathy was associated with lower adjusted odds of survival (OR 0.25, 95% CI 0.12-0.55) and favourable neurological outcome (OR 0.31, 95% CI 0.12-0.81). Bleeding rates were 38, 12 and 2.5 events per 100 patient-days across the respective phenotypes.
Coagulation phenotypes at ECPR initiation were associated with markedly different outcomes. These exploratory findings require independent validation before clinical application.
Study limitation: Observational clustering cannot establish causality; phenotypes also correlated with ischaemic burden, and independent validation is needed.
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