Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis

Overcoming limitations in out-of-hospital cardiac arrest extracorporeal cardiopulmonary resuscitation: optimizing assessment and patient selection for future clinical trials

“…The reported results are consistent with other recently published clinical trials and meta-analyses. [2][3][4] Perhaps most interestingly, the authors reported a significant improvement in 30-day or in-hospital (short-term) neurological outcomes with no heterogeneity. 1 These results are interesting because a concurrent meta-analysis has shown a significant benefit of ECPR in patients with OHCA, but only in the long term (!90 days after cardiac arrest).…”

“…1 These results are interesting because a concurrent meta-analysis has shown a significant benefit of ECPR in patients with OHCA, but only in the long term (!90 days after cardiac arrest). 2 As has been pointed out, the observed differences in results reflect the substantial heterogeneity in confounders because of patient selection, cost-effectiveness, and local technical and logistical challenges. 2 Such inhomogeneity may negate the potential benefits of ECPR by increasing the risk of brain injury and organ failure.…”

“…2 As has been pointed out, the observed differences in results reflect the substantial heterogeneity in confounders because of patient selection, cost-effectiveness, and local technical and logistical challenges. 2 Such inhomogeneity may negate the potential benefits of ECPR by increasing the risk of brain injury and organ failure. 2 Given these contrasting findings, we agree that more studies are needed to elucidate appropriate patient populations and the timing of ECPR among OHCA patients.…”

“…2 Such inhomogeneity may negate the potential benefits of ECPR by increasing the risk of brain injury and organ failure. 2 Given these contrasting findings, we agree that more studies are needed to elucidate appropriate patient populations and the timing of ECPR among OHCA patients. However, we would like to highlight additional methodological aspects that need to be accounted for when designing future clinical trials.…”

Out-of-hospital extracorporeal cardiopulmonary resuscitation: No

“…Because patients are highly selected, activations of the program are going to be rare (30 patients in 4 years in Lyon, France) implying that emergency teams have to refresh their training on a regular basis to stay efficient [9,12,13]. In an univariate meta-regression, center volume of ECPR implementation has been associated with reduced odds of mortality [5]. As stated by Whitmore et al, simulation training should probably be refreshed every 3 months [12].…”