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

Abstract

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.

Predictors of Favorable Neurologic Outcomes in a Territory-First Extracorporeal Cardiopulmonary Resuscitation Program

“…4 Survival after CA is most meaningful when accompanied by favorable neurologic outcome, with a reported rate of 25.2% in a systematic review. 8 The overall 18.6% 3-month favorable neurologic outcome in our cohort was comparable and showed that territory-wide pilot programs could be successful after reorganization of hospital resuscitation procedures – with early involvement of the mobile ECMO team and cardiology support for emergency coronary revascularization when appropriate.…”

“…The nECPR score, which was developed to predict neurologic outcomes, performed better than the ECPR score in predicting favorable 3-month neurologic outcomes (nECPR score -median [IQR], 14.1 [9.9-23] vs. 22. 1 [18.6-29.8]; P = 0.002; AUROC, 0.73; 95% CI, 0.61 to 0.86; ECPR score -median [IQR], 10 [10][11][12] vs. 9 [7][8][9][10]; P = 0.002; AUROC, 0.72; 95% CI, 0.59 to 0.85). We showed that incorporating APACHE IV scores to the nECPR score further increased the performance of the model (AUROC, 0.80; 95% CI, 0.70 to 0.90) (see Figure 2b).…”

Prognostic significance of the blood urea nitrogen to creatinine ratio in in-hospital cardiac arrest after targeted temperature management

“…Although their patients undergoing extracorporeal membrane oxygenation were twice as many as ours, our subjects had a better prognosis regardless of the selection bias of opting for patients with better conditions in ECMO therapy. 28 Second, our relatively small sample size potentially interferes with the power of the results. Furthermore, in their study, good neurological status was substantial (17.0% among all patients with IHCA) at the 12-month follow-up.…”

Clinician Perspectives on Cannulation for Extracorporeal Cardiopulmonary Resuscitation: A Mixed Methods Analysis

“…[3][4][5] Extracorporeal cardiopulmonary resuscitation (ECPR), achieved via the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in conjunct with CCPR, is a promising technique that supports a subgroup of critically ill OHCA patients by providing increased perfusion. [6][7][8] However, ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system. 9 This highly invasive therapy is costly to implement, has a setup time ranging between 15 and 30 minutes and the procedure itself can cause life-threatening complications to the patient.…”