Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Peigh, Graham; Cavarocchi, Nicholas C.; Hirose, Hitoshi

doi:10.1016/j.jtcvs.2015.07.061

Cited by 30 publications

(33 citation statements)

References 23 publications

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“…After excluding the duplicated papers, review or meeting abstracts, and irrelevant articles, 60 articles were left for further screening by checking the full texts. 47 articles were excluded, of which, seven were overlapped studies [42][43][44][45][46][47][48], seven were performed in pediatric patients [49][50][51][52][53][54][55], two study contained patients with other disease besides CA and the data related to CA could not be obtained separately [16,56], three studies contained CA patients treated with other methods besides ECPR and the data related to ECPR could not be obtained separately [17,57,58], fifteen studies had no sufficient data [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73], and eleven studies only had therapeutic hypothermia arms (without controls) [37,[74][75][76][77][78][79][80][81][82][83]. Two...…”

Section: Discussionmentioning

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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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%

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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“…Deben estar presentes entre distintos tipos de reanimadores (legos o profesionales), pueden estar relacionados con el inicio o la culminación del apoyo vital básico o avanzado y pueden estar influenciadas por factores individuales, de la cultura local e internacional, legal, de la tradición, religiosa, social y económica. Estas situaciones de emergencia vital hacen más difícil la toma de decisiones (13)(14)(15)(16)(17) . Se deben guiar por los conocimientos científicos, las preferencias de las personas, por la normativa local y los requisitos legales siempre basados en los principios básicos de la ética.…”

Section: Desarrollounclassified

“…Todos los adultos se consideran capaces de tomar decisiones, excepto los que están legalmente declarados incapaces (11)(12)(13)(14)(15) .…”

Section: Ilcor (International Liaison Committee On Resuscitation) Segunclassified

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Principios éticos de la reanimación cardiopulmonar y cerebral

Cordero-Escobar¹,

Soler-Morejón²

2020

Revista Mexicana De Anestesiología

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Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

Cited by 30 publications

References 23 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

Principios éticos de la reanimación cardiopulmonar y cerebral

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