Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: A systematic review

Beyea, Michael M.; Tillmann, Bourke W; Iansavichene, Alla; Randhawa, Varinder K.; Aarsen, K. Van; Nagpal, Dave

doi:10.1016/j.resuscitation.2018.07.012

Cited by 70 publications

(44 citation statements)

References 68 publications

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“…Due to the observational nature of the studies included in these reviews, the selection of patients for ECPR could still lead to better outcomes for this group. For literature pertaining to OHCA, the same caveats apply [38,39].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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 20, 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%, I 2 = 0%, p = 0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI 80-88%, I 2 = 24%, p = 0.90). Conclusion: ECPR 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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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Using such prognostic scores is complex and requires clinical information that is typically only available after ECMO use. Prognostic factors, such as low-flow time and cardiac rhythm, were found to be related to survival and neurological outcome in patients with in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) who received E-CPR [21][22][23]. Such prognostic factors have not been combined to predict survival in patients with refractory cardiac arrest receiving E-CPR.…”

Section: Introductionmentioning

confidence: 99%

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Siao

Chiu

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution. Methods: This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model. Results: The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flow Time, cardiac arrest Location, and initial cardiac arrest Rhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%, p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%, p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%, p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%, p = 0.0003) than the medium-risk and high-risk groups. Conclusions: Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.

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“…10,[27][28][29] Furthermore, a recent systematic review speculated that the outcome variation in the previous studies might be affected by the structure and experience of the team performing ECPR. 30 Second, ECPR in conditional settings may cause delays in implementation secondary to determination of inclusion. 31 The delay to implement ECPR has been reported as an important prognostic factor in several studies.…”

Section: Discussionmentioning

confidence: 99%

Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

Matsuoka¹,

Ikenoue

Hata

et al. 2019

Resuscitation

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Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is the emerging resuscitative strategy to save refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) patients. We investigated whether the receiving hospitals' ECPR capabilities are associated with outcomes in out-of-hospital cardiac arrest (OHCA) patients who have refractory VF or pulseless VT. Methods: In a population-based cohort study performed in Kobe City, Japan, between 2010 and 2017, we identified all OHCA patients who had refractory VF or pulseless VT. Based on their ECPR capabilities, hospitals were categorised into ECPR facilities and conventional cardiopulmonary resuscitation (CCPR) facilities. We compared patient survivals between ECPR facilities and CCPR facilities by applying inverse probability weighting using a propensity score. Results: Of all 10,971 OHCA patients, 518 had refractory VF or pulseless VT. The proportion of favourable neurologic outcomes was 43/188 (22.9%) in ECPR facilities and 28/330 (8.5%) in CCPR facilities. In the propensity analysis, hospitals' ECPR capabilities were associated with favourable neurologic outcomes (adjusted risk difference [ARD], 9.7% [95% confidence interval [CI], 3.7%-15.7%]; adjusted risk ratio [ARR], 2.01 [95% CI, 1.31-3.09]), and overall survival (87/188 [46.3%] vs. 67/330 [20.3%]; ARD, 19.0% [95% CI, 11.1%-26.9%]; ARR, 1.88 [95% CI, 1.45-2.44]). Conclusions: Hospitals' ECPR capabilities were associated with favourable neurologic outcomes in OHCA patients who had refractory VF or pulseless VT. We should take each hospital's ECPR capability into consideration when developing a regional system of care for OHCA.

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Neurologic outcomes after extracorporeal membrane oxygenation assisted CPR for resuscitation of out-of-hospital cardiac arrest patients: A systematic review

Cited by 70 publications

References 68 publications

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

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

Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

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