Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

Abstract

BACKGROUND:This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients with cardiac arrest (CA).DATA RESOURCES: PubMed, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data (survival, good neurological outcome at discharge, at 3-6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Review Manager 5.3. RESULTS:In six studies 2 260 patients were enrolled to study the survival rate to discharge and longterm neurological outcome published since 2000. A signifi cant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients (RR 2.37, 95%CI 1.63-3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR (RR 2.79, 95%CI 1.96-3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients (RR 2.69, P=0.001). However, no signifi cant difference was found in IHCA patients (RR 1.84, 95%CI 0.91-3.73, P=0.09).CONCLUSION: ECPR showed a benefi cial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA.

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

“…Moreover, the nding that we found substantially less heterogeneity in survival rates between studies than a systematic review of the CCPR literature [1,2] also supports the hypothesis that this is a selected population. Nevertheless, part of the difference might be explained by the effect of ECPR versus CCPR on outcome [45][46][47].…”

Extacorporeal life support using a standard oxygenator as an element of cardiopulmonary resuscitation in cardiosurgicalpatients with in-hospital cardiac arrest

“…В последние годы опубликовано несколько метаанализов, демонстрирующих увеличение выживаемости пациентов до 37,2-54% при включении экстракорпоральной поддержки в комплекс СЛР. Отмечен также более благоприятный неврологический исход при рефрактерной к стандартным реанимационным мероприятиям остановке сердечной деятельности [16][17][18]. В нашем наблюдении выживаемость была схожей и составила 39,1%.…”

Extracorporeal cardiopulmonary resuscitation for in‐ and out‐of‐hospital cardiac arrest: systematic review and meta‐analysis of propensity score‐matched cohort studies

“…Furthermore, ECPR should be viewed as a bridge to definitive treatment for cardiac arrest from reversible cardiac etiologies, so rigorous patient selection may be a way to significantly improve the care of this patient population. 4,5 Although this paper did not delve into details about patient selection, indication, risk of complications, adverse events, and prognostication related to ECPR for cardiac arrest, 47,[55][56][57][58] it did make efforts to report the survival rates and functional outcomes of the studies that used propensity score-matched analysis as part of the study design, to adjust for confounding variables and to reduce treatment selection bias. [11][12][13][14][15][16] Additionally, this paper did not evaluate the costeffectiveness of VA-ECMO used as ECPR for refractory cardiac arrest.…”