Extracorporeal cardiopulmonary resuscitation for cardiac arrest: A systematic review

Holmberg, Mathias J.; Géri, Guillaume; Wiberg, Sebastian; Guerguerian, Anne Marie; Donnino, Michael W.; Nolan, Jerry P.; Deakin, Charles D.; Andersen, Lars W.

doi:10.1016/j.resuscitation.2018.07.029

Cited by 209 publications

(158 citation statements)

References 51 publications

Supporting

Mentioning

144

Contrasting

Unclassified

Order By: Relevance

“…Some reports have shown good outcomes from extracorporeal circulation during CPR but, overall, the evidence of benefit is scarce and limited by the observational nature of the studies. 68 Extracorporeal circulation during CPR may help carefully selected patients, but balance must be achieved between efficient resource use and clinical benefits.…”

Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

Self Cite

629

535

View full text Add to dashboard Cite

IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

Self Cite

629

535

View full text Add to dashboard Cite

show abstract

“…42 Fortunately, five ongoing randomized controlled trials will hopefully fill this knowledge gap in the upcoming years. 20 Third, the longterm effects of complications of ECPR should be investigated, since they could decrease the cost-effectiveness of the intervention. The knowledge gained from further research could improve implementation and cost-effectiveness of this costly and labour-intensive intervention.…”

Section: Discussionmentioning

confidence: 99%

“…16 Although evidence from randomized controlled trials is lacking, 17 observational studies have repeatedly shown an increase in survival after ECPR compared to conventional CPR. [18][19][20] Furthermore, the American Heart association recommends the in-hospital use of ECPR in patients with a reversible cause of CA (e.g. : acute coronary syndrome).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest: A Markov decision model

et al. 2019

View full text Add to dashboard Cite

Background: This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment.Methods: A decision tree and Markov model were constructed based on current literature. The model was conditional on age, Charlson Comorbidity Index (CCI) and sex. Three treatment strategies were considered: ECPR for patients with an Age-Combined Charlson Comorbidity Index (ACCI) below different thresholds (2-4), ECPR for everyone (EALL), and ECPR for no one (NE). Cost-effectiveness was assessed with costs per quality-of-life adjusted life years (QALY). Measurements and main results: Treating eligible patients with an ACCI below 2 points costs 8394 (95% CI: 4922-14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8825 (95% CI: 5192-15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5478-16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10,818 (95% CI: 6357-19,400) euro per extra QALY per IHCA patient.For WTP thresholds of 0-9500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9500 and 12,500, treating eligible patients with an ACCI below 4 has the highest probability of being the most cost-effective strategy. For WTP thresholds of 12,500 or higher, EALL was found to have the highest probability of being the most costeffective strategy. Conclusions:Given that conventional WTP thresholds in Europe and North-America lie between 50,000-100,000 euro or U.S. dollars, ECPR can be considered a cost-effective treatment after in-hospital cardiac arrest from a healthcare perspective. More research is necessary to validate the effectiveness of ECPR, with a focus on the long-term effects of complications of ECPR.

show abstract

“…However, if done in settings with the appropriate resources utilizing an aggressive strategy with optimum patient selection, survival can possibly be favorable [14]. However, evidence remains inconclusive and requires further study [66].…”

Section: Special Mention: Out-of-hospital Ecprmentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation

Farhat¹,

Bowens²,

Thiagarajan³

et al. 2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

View full text Add to dashboard Cite

ECMO, or extracorporeal membrane oxygenation, is an advanced life support technique that provides cardiac and pulmonary support similar to cardiopulmonary bypass. ECPR (extracorporeal cardiopulmonary resuscitation) is the rapid deployment of VA-ECMO when conventional cardiopulmonary resuscitation fails to provide return of spontaneous circulation. Evidence in the literature is sparse, but with expanding reported applications, ECPR has shown promise to improve outcomes of cardiac arrest. ECPR is superior to conventional CPR for both survival and neurologic outcomes. ECPR has been successfully used to manage arrests secondary to cardiac and non-cardiac causes. Arrests secondary to primary cardiac causes have the best overall outcome. Other determinants of outcomes of ECPR include duration of low flow state and on-ECMO complications. A narrow list of ECPR contraindications exists, and includes severe neurologic injury and irreversible primary disease process. Various complications can occur with ECPR, and include mechanical, cardiovascular, pulmonary, hematologic, renal, and neurologic complications. Neurologic complications are the most serious, and significantly affect mortality or quality of life. ECPR is a nascent field, and substantial work remains to be done to optimize its application. Given the small number of patients at each institutional level, this is a field ripe for collaborative work and rewarding results.

show abstract

Extracorporeal cardiopulmonary resuscitation for cardiac arrest: A systematic review

Abstract: There is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies is very low.

Cited by 209 publications

References 51 publications

In-Hospital Cardiac Arrest

In-Hospital Cardiac Arrest

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest: A Markov decision model

Extracorporeal Cardiopulmonary Resuscitation

Contact Info

Product

Resources

About