Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Abstract

BackgroundIn hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. MethodsWe performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. ResultsOur search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 31% (95% CI: 28-33%, I2=0%, p=0.26). In the surviving patients, the pooled percentage of favourable neurological outcome was 83% (95% CI: 79-87%, I2=24%, p=0.75). ConclusionECPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.

Survival and Outcomes After Cardiac Arrest With VA-ECMO Rescue Therapy

“…Neurologic outcome after ECPR was analyzed in a systematic review and meta-analysis by Gravesteijn et al who identified 19 studies where neurologic outcome was assessed using the CPC score (8). They found that in survivors, the proportion of favorable neurologic outcome (CPC of 1-2) was high (84%) with a low study heterogeneity (I 2 ¼ 24%, P ¼ 0.90).…”

Extracorporeal life support in adult patients with out-of-hospital cardiac arrest

“…Several systematic reviews have compared ECPR with CCPR and suggested that ECPR might be associated with improved survival to discharge or neurological outcomes. (23)(24)(25)(26)(27) However, all systematic reviews have rated the quality of evidence as low, with risk of bias. A recent systematic review by Holmberg et al for the International Liaison Committee on Resuscitation's Advanced Life Support and Paediatric Task Forces demonstrated mixed results.…”