Journal Article

Does extracorporeal cardiopulmonary resuscitation improve survival with favorable neurological outcome in out-of-hospital cardiac arrest? A systematic review and meta-analysis

Sinagra, Gianfranco, Pagura, Linda, Rakar, Serena, Stolfo, Davide, Fabris, Enrico, Mazzaro, Enzo, Gabrielli, Marco

2024

Overview

Extracorporeal cardiopulmonary resuscitation (E-CPR) may improve survival with favorable neurological outcome in patients with refractory out-of-hospital cardiac arrest (OHCA). Unfortunately, recent results from randomized controlled trials were inconclusive. We performed a meta-analysis to investigate the impact of E-CPR on neurological outcome compared to conventional cardiopulmonary resuscitation (C-CPR). A systematic research for articles assessing outcomes of adult patients with OHCA either treated with E-CPR or C-CPR up to April 27, 2023 was performed. Primary outcome was survival with favorable neurological outcome at discharge or 30 days. Overall survival was also assessed. Eighteen studies were included. E-CPR was associated with better survival with favorable neurological status at discharge or 30 days (14% vs 7%, OR 2.35, 95% CI 1.61–3.43, I2 = 80%, p < 0.001, NNT = 17) than C-CPR. Results were consistent if the analysis was restricted to RCTs. Overall survival to discharge or 30 days was also positively affected by treatment with E-CPR (OR = 1.71, 95% CI = 1.18–2.46, I2 = 81%, p = 0.004, NNT = 11). In this meta-analysis, E-CPR had a positive effect on survival with favorable neurological outcome and, to a smaller extent, on overall mortality in patients with refractory OHCA. •Evidence on E-CPR benefit in out-of-hospital cardiac arrest is inconclusive•This updated meta-analysis included 15 observational studies and 3 RCTs•E-CPR patients showed better short-term survival with good neurological status•The superiority of E-CPR on C-CPR persisted at 180 days outcome analysis•This meta-analysis supports the use of E-CPR in out-of-hospital cardiac arrest

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Bias / Cardiac arrest / Cardiopulmonary resuscitation / Cardiopulmonary Resuscitation - methods / Cardiopulmonary Resuscitation - statistics & numerical data / Conventional cardiopulmonary resuscitation / CPR / Extracorporeal circulation / Extracorporeal Membrane Oxygenation - methods / Extracorporeal Membrane Oxygenation - statistics & numerical data / Humans / Meta-analysis / Observational studies / Out-of-Hospital Cardiac Arrest - complications / Out-of-Hospital Cardiac Arrest - mortality / Out-of-Hospital Cardiac Arrest - therapy / Refractory cardiac arrest / ROSC / Systematic review / Treatment Outcome / VA-ECMO