An observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction

Chou, Tzung-Hsin; Fang, Cheng-Chung; Yen, Zui-Shen; Lee, Chien‐Chang; Chen, Yih‐Sharng; Ko, Wen‐Je; Wang, Chih‐Hsien; Wang, Shoei‐Shen; Chen, Shyr‐Chyr

doi:10.1136/emermed-2012-202173

Cited by 56 publications

(48 citation statements)

References 39 publications

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“…Finally, 6 studies were included in the metaanalysis comprising 2 260 CA patients, in which 376 and 1 884 patients received ECPR and CCPR respectively. [7][8][9][10][11][12] Those included were all 7-star or 8-star studies according to the NOS grade, suggesting high literature methodology quality. The detailed characteristics of the included studies were shown in Table 1.…”

Section: Eligible Studies and Characteristics Of Included Studiesmentioning

confidence: 99%

“…This procedure demonstrated A predefi ned subgroup analysis was performed according to the location of CA (IHCA or OHCA). Four studies were selected from the subgroup of IHCA [7,8,10,12] and three studies from the subgroup of OHCA. [9,11,12] There was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients (RR 2.69, 95%CI 1.48-4.91, P=0.001) (Figure 4) …”

Section: Subgroup and Sensitivity Analysismentioning

confidence: 99%

“…[3] Extracorporeal CPR (ECPR) is a technique to circulate blood outside the body with extracorporeal oxygenation and to support the body's circulation in the absence of an adequately functioning cardiac pump. [6] Observation studies [7][8][9][10][11][12] have shown an improved survival rate and better neurological preservation after CA in patients receiving ECPR compared to CCPR. ECPR is a valuable option for CA and that it should be initiated as soon as possible when CA is considered to be refractory to CCPR.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

Wang

Chen

Qiao

et al. 2017

World Journal of Emergency Medicine

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BACKGROUND:This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients with cardiac arrest (CA).DATA RESOURCES: PubMed, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data (survival, good neurological outcome at discharge, at 3-6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Review Manager 5.3. RESULTS:In six studies 2 260 patients were enrolled to study the survival rate to discharge and longterm neurological outcome published since 2000. A signifi cant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients (RR 2.37, 95%CI 1.63-3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR (RR 2.79, 95%CI 1.96-3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients (RR 2.69, P=0.001). However, no signifi cant difference was found in IHCA patients (RR 1.84, 95%CI 0.91-3.73, P=0.09).CONCLUSION: ECPR showed a benefi cial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA.

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Section: Eligible Studies and Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Subgroup and Sensitivity Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

Wang

Chen

Qiao

et al. 2017

World Journal of Emergency Medicine

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“…In this setting, Ouweneel et al gathered these heterogeneous studies and their meta-analysis brings new insights although no prospective randomized controlled trials exist yet. They selected nine retrospective studies (4,(7)(8)(9)(10)(11)(12)(13)(14), comparing E-CPR vs. conventional CPR (C-CPR), resulting in a total of 3.098 patients (708 ECLS vs. 2.390 control). Outcomes were 30-day survival rate and favorable neurological outcomes [Glasgow-Pittsburgh cerebralperformance categories (CPC) score of 1 or 2] at 30 days evaluated by total cohort and propensity-matched cohort analysis (when available).…”

mentioning

confidence: 99%

“…Indeed, it is worth remembering that PCI is associated with better survival, which is made possible by ECLS for the most severe patients. Lastly, this meta-analysis constantly mixes studies focused on IHCA (4,7,8,10) and OHCA (9-12) with obviously very different survival rates (17). In our opinion, IHCA and OHCA have such distinct presentation, management delays, and outcome that mixing these two populations preclude raising any solid clinical message on E-CPR use.…”

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confidence: 99%

Meta-analysis on extracorporeal life support during cardiac arrest: do not compare apples and oranges

Rozencwajg

Schmidt

2017

Ann. Transl. Med.

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Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

Parr

Sharma

Arora

et al. 2019

Cathet Cardio Intervent

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Objectives The aims of this single‐center retrospective study were to characterize and determine predictors of 30‐day survival in a cohort of patients requiring venoarterial extracorporeal membrane oxygenation (VA‐ECMO) supported cardiopulmonary resuscitation (E‐CPR) in the cardiac catheterization laboratory (CCL) for cardiac arrest (CA) or refractory cardiogenic shock (CS). Background While safety in the CCL has improved, periprocedural mortality from CA remains high. The application of VA‐ECMO is an emerging form of resuscitation with a paucity of data evaluating its use in the CCL for CA or CS. Methods All consecutive patients aged 18 years or older presenting to a single CCL from October 2010 to May 2018 who required E‐CPR for CA or refractory CS were included. The primary outcome of our study was overall survival 30 days from VA‐ECMO initiation. Secondary outcomes included 1‐year survival, hospital length of stay, and ECMO related complications. Results Sixty‐two patients with a mean age of 60 ± 9 years, 63% male, were included. VA‐ECMO was initiated for CA in 39 patients (63%) and for CS in 23 patients (37%). The median ECMO duration was 48 hr. Overall 30‐day survival was 47% (CA group 44% vs. CS group 52%; p = .414). One‐year survival was 44%. Initial serum creatinine (OR 1.18 per 10 μmol/L increase; p = .016; AUC = 0.65) was the only multivariate predictor of 30‐day mortality. Conclusions The use of VA‐ECMO in the CCL is feasible, demonstrating 47% 30‐day survival, largely persistent to 1 year, in a cohort that otherwise has extremely high mortality.

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An observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction

Abstract: ECPR may improve survival in cardiac arrest patients who have a ST segment elevation or initial rhythm of VT/VF myocardial infarction.

Cited by 56 publications

References 39 publications

Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

Meta-analysis on extracorporeal life support during cardiac arrest: do not compare apples and oranges

Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory

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