Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: A propensity-matched analysis

Abstract

In our cohort of cardiovascular patients ECPR was associated with better short- and long-term survival over CCPR, with a good neurological outcome in the majority of the patients with refractory in-hospital cardiac arrest.

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

“…Several factors are related to the outcomes, including immediate recognition of CA, early CPR, rapid defibrillation, initial rhythm, underlying cause of CA, duration of CPR and initial resuscitation effort as well as integrated post-CA care. [16] Because cerebral blood fl ow is insuffi cient during CPR, there is the possibility of ECPR using a cardiopulmonary support device for the recovery of neurological function. ECPR was introduced in the 1960s to improve neurological outcomes.…”

Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR)

“…B. Myokardinfarkt oder Lungenarterienembolie; [10][11][12]). Beobachtungsstudien deuten darauf, dass die eCPR bei diesen selektierten IHCA-und OHCAPatienten im Vergleich mit der konventionellen CPR mit einer Zunahme der Überlebensrate von bis zu 30 % einhergeht [4,[13][14][15][16][17][18][19][20][21][22]. In einer Metaanalyse zeigte sich eine um 13 % verbesserte Überlebenswahrscheinlichkeit im Vergleich zur konventionellen CPR (95 %-Konfidenzintervall [95 %-KI] 6-20 %; p < 0,001; "number needed to treat" 7,7; [23] …”

Meta-analysis on extracorporeal life support during cardiac arrest: do not compare apples and oranges

“…In this setting, Ouweneel et al gathered these heterogeneous studies and their meta-analysis brings new insights although no prospective randomized controlled trials exist yet. They selected nine retrospective studies (4,(7)(8)(9)(10)(11)(12)(13)(14), comparing E-CPR vs. conventional CPR (C-CPR), resulting in a total of 3.098 patients (708 ECLS vs. 2.390 control). Outcomes were 30-day survival rate and favorable neurological outcomes [Glasgow-Pittsburgh cerebralperformance categories (CPC) score of 1 or 2] at 30 days evaluated by total cohort and propensity-matched cohort analysis (when available).…”

“…Indeed, it is worth remembering that PCI is associated with better survival, which is made possible by ECLS for the most severe patients. Lastly, this meta-analysis constantly mixes studies focused on IHCA (4,7,8,10) and OHCA (9-12) with obviously very different survival rates (17). In our opinion, IHCA and OHCA have such distinct presentation, management delays, and outcome that mixing these two populations preclude raising any solid clinical message on E-CPR use.…”

“…Herein, 438 and 195 patients were matched for 30-day survival and neurological outcome evaluation, respectively (4,7,9,11,14). Despite a major reduction in the number of included patients, results remain in favor of E-CPR group for both 30-day survival rates (risk difference 14%; 95% CI 2-25%; P=0.02; number needed to treat 7.1) and favorable neurological outcome (risk difference 13%; 95% CI 7-20%; P=0.0001; NNT 7.7) ( Table 1).…”