Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis

• Published in: Journal of critical care Vol. 84; p. 154882
• Main Authors: Pagura, Linda, Fabris, Enrico, Rakar, Serena, Gabrielli, Marco, Mazzaro, Enzo, Sinagra, Gianfranco, Stolfo, Davide
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2024; Elsevier Limited
• Subjects: Bias; Cardiac arrest; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - statistics & numerical data; Conventional cardiopulmonary resuscitation; CPR; Extracorporeal circulation; Extracorporeal Membrane Oxygenation - methods; Extracorporeal Membrane Oxygenation - statistics & numerical data; Humans; Medicin och hälsovetenskap; Meta-analysis; Observational studies; Out-of-Hospital Cardiac Arrest - complications; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Refractory cardiac arrest; ROSC; Systematic review; Treatment Outcome; VA-ECMO; United States > US; OHCA; CPR; Conventional cardiopulmonary resuscitation; NNT; Refractory cardiac arrest; RCTs; CPC; ROSC; E-CPR; C-CPR; VA-ECMO; Extracorporeal circulation
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154882

Extracorporeal cardiopulmonary resuscitation (E-CPR) may improve survival with favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest (OHCA). Unfortunately, recent results from randomized controlled trials were inconclusive. We performed a meta-analysis to investigate the impact of E-CPR on neurological outcome compared to conventional cardiopulmonary resuscitation (C-CPR). A systematic research for articles assessing outcomes of adult patients with OHCA either treated with E-CPR or C-CPR up to April 27, 2023 was performed. Primary outcome was survival with favorable neurological outcome at discharge or 30 days. Overall survival was also assessed. Eighteen studies were included. E-CPR was associated with better survival with favorable neurological status at discharge or 30 days (14% vs 7%, OR 2.35, 95% CI 1.61–3.43, I2 = 80%, p < 0.001, NNT = 17) than C-CPR. Results were consistent if the analysis was restricted to RCTs. Overall survival to discharge or 30 days was also positively affected by treatment with E-CPR (OR = 1.71, 95% CI = 1.18–2.46, I2 = 81%, p = 0.004, NNT = 11). In this meta-analysis, E-CPR had a positive effect on survival with favorable neurological outcome and, to a smaller extent, on overall mortality in patients with refractory OHCA. •Evidence on E-CPR benefit in out-of-hospital cardiac arrest is inconclusive•This updated meta-analysis included 15 observational studies and 3 RCTs•E-CPR patients showed better short-term survival with good neurological status•The superiority of E-CPR on C-CPR persisted at 180 days outcome analysis•This meta-analysis supports the use of E-CPR in out-of-hospital cardiac arrest