Extracorporeal cardiopulmonary resuscitation for cardiac arrest: An updated systematic review

Holmberg, Mathias J.; Granfeldt, Asger; Guerguerian, Anne‐Marie; Sandroni, Claudio; Hsu, Cindy H.; Gardner, Ryan; Lind, P; Eggertsen, Mark A.; Johannsen, Cecilie Munch; Andersen, Lars W.

doi:10.1016/j.resuscitation.2022.12.003

Cited by 34 publications

(35 citation statements)

References 56 publications

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“…These four long‐awaited RCTs 8,9,18,24 were pooled together for the first time in this meta‐analysis. In previous systematic reviews or meta‐analyses, 16,27–30 RCTs were not available yet, and thus not included, or were not pooled together. Observational studies are at high risk of bias, especially with extracorporeal CPR, where the decision to treat is based on clinicians' evaluation and comorbidities and prognostic factors with a strong impact on the outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Differently from our previous meta-analysis 10 and other systematic reviews published on the topic, 16,[27][28][29][30] the present meta-analysis provided for the first time a pooled estimate of the effect of extracorporeal CPR with data only from RCTs, including all the available RCTs in the field, 8,9,18 comprising the first multi-center RCT published in 2023. 24 Despite these important strengths, two limitations should be acknowledged.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials

et al. 2023

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Background:In adults with refractory out-of-hospital cardiac arrest, when conventional cardiopulmonary resuscitation (CPR) alone does not achieve return of spontaneous circulation, extracorporeal CPR is attempted to restore perfusion and improve outcomes. Considering the contrasting findings of recent studies, we conducted a meta-analysis of randomized controlled trials to ascertain the effect of extracorporeal CPR on survival and neurological outcome. Methods: Pubmed via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched up to February 3, 2023, for randomized controlled trials comparing extracorporeal CPR versus conventional CPR in adults with refractory out-of-hospital cardiac arrest. Survival with a favorable neurological outcome at the longest follow-up available was the primary outcome. Results: Among four randomized controlled trials included, extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome at the longest follow-up available for all rhythms (59/220 [27%] vs. 39/213 [18%]; OR = 1.72; 95% CI, 1.09-2.70; p = 0.02; I 2 = 26%; number needed to treat of 9), for initial shockable rhythms only (55/164 [34%] vs. 38/165 [23%]; OR = 1.90; 95% CI, 1.16-3.13; p = 0.01; I 2 = 23%; number needed to treat of 7), and at hospital discharge or 30 days (55/220 [25%] vs. 34/212 [16%]; OR = 1.82; 95% CI, 1.13-2.92; p = 0.01; I 2 = 0.0%). Overall survival at the longest follow-up available was similar (61/220 [25%] vs. 34/212 [16%]; OR = 1.82; 95% CI, 1.13-2.92; p = 0.59; I 2 = 58%).Conclusions: Extracorporeal CPR compared with conventional CPR increased survival with favorable neurological outcome in adults with refractory out-ofhospital cardiac arrest, especially when the initial rhythm was shockable.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Refractory out‐of‐hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: A meta‐analysis of randomized trials

et al. 2023

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“…Three recent randomized clinical trials tested the benefits of ECPR for patients with out-of-hospital cardiac arrest. 6,7 A clinical trial of 30 patients with refractory ventricular fibrillation by Yannopoulos et al reported that the rate of survival to hospital discharge was 43% with ECPR compared with 7% in those receiving conventional CPR (risk difference, 36% [95% CI, 4%-59%]). 5 This trial was terminated early due to superiority of ECPR.…”

Section: Clinical Trial Evidencementioning

confidence: 99%

“…Prehospital initiation of ECPR is currently being tested in randomized clinical trials. 7 Current clinical trials have only included patients with out-ofhospital cardiac arrest of a presumed cardiac origin or with an initial ventricular arrhythmia. The potential benefit of ECPR in other patient populations, such as those with out-of-hospital cardiac arrest with a noncardiac origin or patients with in-hospital cardiac arrest, is unknown.…”

Section: Uncertainties and Future Perspectivesmentioning

confidence: 99%