{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:04:25Z","timestamp":1789365865990,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute myocardial infarction (AMI) complicated by refractory cardiac arrest (CA) carries extremely high mortality and neurological disability rates. Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue intervention for this population, but outcomes after its use vary widely across individuals. Low-flow time (the interval from initiation of chest compressions to establishment of stable ECMO flow) is an important prognostic factor among ECPR-treated patients. Its association with outcomes in Chinese patients with AMI-related CA remains incompletely characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 161 eligible adult patients with AMI-related refractory CA who received ECPR at our tertiary center between January 2019 and December 2025. The primary endpoint was 30-day unfavorable neurological outcome [Cerebral Performance Category (CPC) score 3-5]. Multivariable logistic regression evaluated low-flow time continuously as the primary exposure. RCS regression assessed possible nonlinearity, whereas ROC analysis provided a secondary, exploratory cohort-specific classification. We performed an exact-timing sensitivity analysis and a full-cohort interaction analysis to assess heterogeneity by arrest setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 161 enrolled patients, 118 (73.3%) had 30-day unfavorable neurological outcomes, including 104 deaths (64.6%). After multivariable adjustment, each additional minute of low-flow time was associated with higher odds of unfavorable outcome (aOR 1.065, 95% CI 1.036\u20131.096;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). The association remained in 132 patients with exact timing (aOR 1.082, 95% CI 1.042\u20131.124;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In a parsimoniously adjusted interaction model, the estimated aOR per minute was 1.061 (95% CI 1.027\u20131.096) for IHCA and 1.072 (95% CI 1.023\u20131.124) for OHCA; the interaction was not statistically detectable (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.708). RCS did not detect nonlinearity (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.660). The exploratory 50.9-min classification was internally derived and its bootstrap cutpoints were widely distributed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among selected AMI patients who received ECPR, increasing low-flow time was progressively associated with unfavorable 30-day neurological outcome, with no detected nonlinear inflection or evidence of effect modification by arrest setting. These findings are prognostic among ECPR-treated patients and do not define when ECPR should or should not be initiated. The internally derived 50.9-min classification is exploratory and is not an eligibility threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1942551","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:39:40Z","timestamp":1789364380000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-flow time and neurological outcomes in AMI patients undergoing ECPR: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Bingwei","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanwei","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.resuscitation.2020.05.038","article-title":"Relationship between hemodynamic parameters and cerebral blood flow during cardiopulmonary 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