Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience

Dennis, Mark; McCanny, Peter; D’Souza, Mario; Forrest, Paul; Burns, Brian; Lowe, David; Gattas, David; Scott, Sean; Bannon, Paul G.; Granger, Emily; Pye, R.; Totaro, Richard

doi:10.1016/j.ijcard.2016.12.003

Cited by 79 publications

(75 citation statements)

References 38 publications

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“…Two studies did not state the specific temperature of therapeutic hypothermia and control arms [84,85]. Finally, 13 papers containing 1159 cases were included in the present study [9,[25][26][27][28][29][30][31][32][33][34][35][36]. Notably, two papers published by Kagawa et al in 2012 and 2015 with some overlapped participants were both included because they reported different clinical outcomes [25,27]…”

Section: Discussionmentioning

confidence: 99%

“…ECPR is an ideal tool for rapid and homogenous cooling and can also be augmented with surface cooling. Up to now, there are some studies evaluating the combined use of ECPR and therapeutic hypothermia in adult CA patients and/or comparing therapeutic hypothermia treatment with no therapeutic hypothermia induction [9,[25][26][27][28][29][30][31][32][33][34][35][36][37]. However, the sample size of those studies is limited, the proportion of patients receiving therapeutic hypothermia ranges variously, and no conclusive result is derived whether there is a benefit of therapeutic hypothermia treatment in CA patients undergoing ECPR.…”

Section: Introductionmentioning

confidence: 99%

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Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

Chen

Zhen

Jia

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Therapeutic hypothermia has been recommended for eligible patients after cardiac arrest (CA) in order to improve outcomes. Up to now, several comparative observational studies have evaluated the combined use of extracorporeal cardiopulmonary resuscitation (ECPR) and therapeutic hypothermia in adult patients with CA. However, the effects of therapeutic hypothermia in adult CA patients receiving ECPR are inconsistent. Methods: Relevant studies in English databases (PubMed, ISI web of science, OVID, and Embase) were systematically searched up to September 2019. Odds ratios (ORs) from eligible studies were extracted and pooled to summarize the associations of therapeutic hypothermia with favorable neurological outcomes and survival in adult CA patients receiving ECPR.Results: 13 articles were included in the present meta-analysis study. There were nine studies with a total of 806 cases reporting the association of therapeutic hypothermia with neurological outcomes in CA patients receiving ECPR. Pooling analysis suggested that therapeutic hypothermia was significantly associated with favorable neurological outcomes in overall (N = 9, OR = 3.507, 95%CI = 2.194-5.607, P < 0.001, fixed-effects model) and in all subgroups according to control type, regions, sample size, CA location, ORs obtained methods, follow-up period, and modified Newcastle Ottawa Scale (mNOS) scores. There were nine studies with a total of 806 cases assessing the association of therapeutic hypothermia with survival in CA patients receiving ECPR. After pooling the ORs, therapeutic hypothermia was found to be significantly associated with survival in overall (N = 9, OR = 2.540, 95%CI = 1.245-5.180, P = 0.010, random-effects model) and in some subgroups. Publication bias was found when evaluating the association of therapeutic hypothermia with neurological outcomes in CA patients receiving ECPR. Additional trim-and-fill analysis estimated four "missing" studies, which adjusted the effect size to 2.800 (95%CI = 1.842-4.526, P < 0.001, fixed-effects model) for neurological outcomes.Conclusions: Therapeutic hypothermia may be associated with favorable neurological outcomes and survival in adult CA patients undergoing ECPR. However, the result should be treated carefully because it is a synthesis of low-level evidence and other limitations exist in present study. It is necessary to perform randomized controlled trials to validate our result before considering the result in clinical practices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

Chen

Zhen

Jia

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…None replied after multiple attempts, therefore these studies were excluded. Finally, 19 articles were included [17,18,[27][28][29][30][31][32][33][34][35][19][20][21][22][23][24][25][26] (Fig 1).…”

Section: Included Articlesmentioning

confidence: 99%

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

Gravesteijn

Schluep

Disli

et al. 2020

Preprint

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Background: In hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. Methods: We performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. Results: Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI: 28-33%, I2=0%, p=0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI: 80-88%, I2=24%, p=0.90). Conclusion: CPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.

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“…ECPR use for victims of cardiac arrest consistently demonstrates a survival benefit over conventional CPR [5][6][7][8]. This survival benefit is more pronounced as the duration of CPR increases.…”

Section: Ecpr Is Superior To Conventional Cprmentioning

confidence: 95%

Extracorporeal Cardiopulmonary Resuscitation

Farhat¹,

Bowens²,

Thiagarajan³

et al. 2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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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.

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Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience

Cited by 79 publications

References 38 publications

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

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

Extracorporeal Cardiopulmonary Resuscitation

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