A Comparison between Conventional and Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Abstract

There is limited evidence comparing the use of extracorporeal cardiopulmonary resuscitation (ECPR) to CPR in the management of refractory out-of-hospital cardiac arrest (OHCA). We conducted a systematic review and meta-analysis to compare survival and neurologic outcomes associated with ECPR versus CPR in the management of OHCA. We searched PubMed, EMBASE, and Scopus to identify observational studies and randomized controlled trials comparing ECPR and CPR. We used the Newcastle–Ottawa Scale and Cochrane’s risk-of-bias tool to assess studies’ quality. We used random-effects models to compare outcomes between the pooled populations and moderator analysis to identify sources of heterogeneity and perform subgroup analysis. We identified 2088 articles and included 13, with 18,620 patients with OHCA. A total of 16,701 received CPR and 1919 received ECPR. Compared with CPR, ECPR was associated with higher odds of achieving favorable neurologic outcomes at 3 (OR 5, 95% CI 1.90–13.1, p < 0.01) and 6 months (OR 4.44, 95% CI 2.3–8.5, p < 0.01). We did not find a significant survival benefit or impact on neurologic outcomes at hospital discharge or 1 month following arrest. ECPR is a promising but resource-intensive intervention with the potential to improve long-term outcomes among patients with OHCA.

Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry

“…We could not confirm the positive effects of ECPR. Although controversial, some previous studies have reported the effectiveness of ECPR [ 34 , 35 ]. Since ECPR is performed in highly selected patients, it would be difficult to sufficiently adjust for the different characteristics between the ECPR and no ECPR groups.…”

“…Our study included significant proportion of patients with pulseless electrical activity (21.5% in the no ECPR group and 20.2% in the ECPR group), asystole (21.1% in the no ECPR group and 19.9% in the ECPR group), and unwitnessed OHCA (28.7% in the no ECPR group and 26.6% in the ECPR group), which is less common in other studies [ 6 , 7 , 34 , 35 ]. Although the entire cohort included 484 ECPR patients and 458 patients were included in the matched cohort, the characteristics of patients who received ECPR were similar between the entire ECPR cohort and matched ECPR cohort (Tables 1 and 2 ).…”

Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A meta‐analysis of randomized controlled trials

“…The previous systematic reviews suggested some benefits of ECPR over conventional CPR, but it should be noted that most of the evidence reviewed by these studies was observational in nature. 5,6 Additionally, the most recent review by Holmberg et al did not include a meta-analysis. With the results of recently published RCTs on this topic, 9,11 our study provides more robust evidence regarding the use of ECPR in patients with cardiac arrest.…”

“…4 Although high-quality bystander cardiopulmonary resuscitation (CPR) improves clinical outcomes including neurological outcomes, the overall prognosis for OHCA patients remains poor. 5 Extracorporeal cardiopulmonary resuscitation (ECPR) is a resuscitation method for patients with refractory cardiac arrest, as recommended by the American Heart Association (AHA) and European Resuscitation Council (ERC) guidelines. 6 ECPR can provide gas exchange and circulatory support during cardiac arrest using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) technology.…”

“…8 Data from systematic reviews of mostly observational studies have evaluated the potential benefits of ECPR in OHCA; however, the evidence from randomized clinical trials (RCTs) is limited and conflicting. 5,6 Therefore, we conducted this meta-analysis to aggregate the results of published RCTs evaluating the use of ECPR compared to manual or conventional CPR in patients with OHCA. RCTs.…”