Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis of randomized and propensity score‐matched studies

Abstract

Background:In selected patients with refractory out-of-hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation represents a promising approach when conventional cardiopulmonary resuscitation fails to achieve return of spontaneous circulation. This systematic review and meta-analysis aimed to compare extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 28, 2021, for randomized trials and observational studies reporting propensity score-matched data and comparing adults with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation with those treated with conventional cardiopulmonary resuscitation. The primary outcome was survival with favorable neurological outcome at the longest follow-up available. Secondary outcomes were survival at the longest follow-up available and survival at hospital discharge/30 days. Results: We included six studies, two randomized and four propensity scorematched studies. Patients treated with extracorporeal cardiopulmonary resuscitation had higher rates of survival with favorable neurological outcome (81/584 [14%] vs. 46/593 [7.8%]; OR = 2.11; 95% CI, 1.41-3.15; p < 0.001, number needed to treat 16) and of survival (131/584 [22%] vs. 102/593 [17%]; OR = 1.40; 95% CI, 1.05-1.87; p = 0.02) at the longest follow-up available compared with conventional cardiopulmonary resuscitation. Survival at hospital discharge/30 days was similar between the two groups (142/584 [24%] vs. 122/593 [21%]; OR = 1.26; 95% CI, 0.95-1.66; p = 0.10). Conclusions: Evidence from randomized trials and propensity score-matched studies suggests increased survival and favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest treated with extracorporeal

Effect of annual hospital admissions of out-of-hospital cardiac arrest patients on prognosis following cardiac arrest

“…In addition, E-CPR for out-of-hospital cardiac arrest has been reported to be effective and not, and is an area of discussion [ 34 – 36 ]. In this study, most facilities were able to provide E-CPR regardless of hospital volume, and the percentage of patients who actually received E-CPR ranged from 14.8 to 26.0%.…”

Extrakorporale Reanimation – Kriterien, Bedingungen, Outcome

“…In der Subgruppe ≥ 45 min Reanimation hatten 24 von 26 Patienten mit neurologisch gutem Überleben eine eCPR erhalten. Darüber hinaus weisen zahlreiche nichtrandomisierte Studien und Kohortenanalysen [ 4 , 9 – 12 ] sowie Metaanalysen [ 13 – 15 ] auf verbessertes Überleben mit eCPR in dieser Patientengruppe hin.…”

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

“…Over the last decade, the indications for ECMO support have expanded beyond severe respiratory failure and refractory cardiogenic shock [ 2 ] to include an assortment of clinical presentations, including a bridge to heart or lung transplantation [ 3 ], extracorporeal cardiopulmonary reanimation (ECPR) [ 4 ], resuscitation of patients with severe traumas [ 5 ], and rewarming due to accidental deep hypothermia [ 6 ]. Recently, the use of ECMO support for out-of-hospital cardiac arrest has been popularized in some countries, with reported improvements in outcome [ 7 , 8 , 9 , 10 ].…”