Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis

Abstract

We performed a meta-analysis to compare the impact of extracorporeal cardiopulmonary resuscitation (ECPR) to that of conventional cardiopulmonary resuscitation (CCPR) in adult patients who experience cardiac arrest of cardiac origin. A literature search was performed using criteria set forth in a predefined protocol. Report inclusion criteria were that ECPR was compared to CCPR in adult patients with cardiac arrest of cardiac origin, and that survival and neurological outcome data were available. Exclusion criteria were reports describing non-cardiac origin arrest, review articles, editorials, and nonhuman studies. The efficacies of ECPR and CCPR were compared in terms of survival and neurological outcome. A total of 38,160 patients from 7 studies were ultimately included. ECPR showed similar survival (odds ratio [OR] 2.26, 95% confidence interval [CI] 0.45–11.20) and neurologic outcomes (OR 3.14, 95% CI 0.66–14.85) to CCPR in out-of-hospital cardiac arrest patients. For in-hospital cardiac arrest (IHCA) patients, however, ECPR was associated with significantly better survival (OR 2.40, 95% CI 1.44–3.98) and neurologic outcomes (OR 2.63, 95% CI 1.38–5.02) than CCPR. Hence, ECPR may be more effective than CCPR as an adjuvant therapy for survival and neurologic outcome in cardiac-origin IHCA patients.

Extracorporeal cardiopulmonary resuscitation

“…Although a prospective randomize study has not been performed to evaluate the true clinical impact of ECPR on patient survival, propensity-score based analyses and multiple center-based reports suggest that incorporation of ECLS into standard resuscitation protocols has likely saved the life of thousands of patients who have experienced life-threatening refractory cardiac arrest (9). The beneficial impact of ECPR on survival was highlighted in two recent meta-analyses of studies that compared ECPR to conventional CPR in adults (17,18). Although little difference in out-of-hospital cardiac arrest survival was observed, improved overall survival and neurologic outcome at 3-6 months in patients who received ECPR for in-hospital cardiac arrest.…”

New Developments in the Treatment of Acute Myocardial Infarction Associated with Out-of-Hospital Cardiac Arrest. A Review

“…However, the results were significantly worse in OHCA than in-hospital cardiac arrest (IHCA). [60][61][62][63] A recent meta-analysis on the efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional CPR revealed no differences in survival rates and neurologic outcomes in OHCA patients, despite this therapy leading to improved survival and better neurologic outcome in IHCA of cardiac origin. 64 Another approach, which raises serious ethical questions, is the use of extracorporeal membrane oxygenation (ECMO) to preserve organs for transplantation from refractory OHCA patients.…”

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

“…In a meta-analysis, including 38.160 patients and neurological outcomes as endpoints, ECPR showed significantly better results than conventional CPR for inhospital patients, while for out-of-hospital CA patients the difference between ECPR and standard CPR was not statistically significant [33]. In another study on 955 patients with in-hospital or out-of-hospital CPR, IHCA patients presented a significantly higher rate of survival discharge as compared to OHCA patients (p<0.0001) [34].…”