• Pietro Bertini, Alberto Marabotti, Gianluca Paternoster, Giovanni Landoni, Fabio Sangalli, Adriano Peris, Manuela Bonizzoli, Sabino Scolletta, Federico Franchi, Antonio Rubino, Matteo Nocci, Niccolò Castellani Nicolini, and Fabio Guarracino.
• Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
• J. Cardiothorac. Vasc. Anesth. 2023 Jul 1; 37 (7): 126512721265-1272.

ObjectiveThis systematic review and meta-analysis aimed to investigate the role of regional cerebral oxygen saturation (rSO2) in predicting survival and neurologic outcomes after extracorporeal cardiopulmonary resuscitation (ECPR).DesignThe study authors performed a systematic review and meta-analysis of all available literature.SettingThe authors searched relevant databases (Pubmed, Medline, Embase) for studies measuring precannulation rSO2 in patients undergoing ECPR and reporting mortality and/or neurologic outcomes.ParticipantsThe authors included both in-hospital and out-of-hospital cardiac arrest patients receiving ECPR. They identified 3 observational studies, including 245 adult patients.InterventionsThe authors compared patients with a low precannulation rSO2 (≤15% or 16%) versus patients with a high (>15% or 16%) precannulation rSO2. In addition, the authors carried out subgroup analyses on out-of-hospital cardiac arrest (OHCA) patients.Measurements And Main ResultsA high precannulation rSO2 was associated with an overall reduced risk of mortality in ECPR recipients (98 out of 151 patients [64.9%] in the high rSO2 group, v 87 out of 94 patients [92.5%] in the low rSO2 group, risk differences [RD] -0.30; 95% CI -0.47 to -0.14), and in OHCA (78 out of 121 patients [64.5%] v 82 out of 89 patients [92.1%], RD 0.30; 95% CI -0.48 to -0.12). A high precannulation rSO2 also was associated with a significantly better neurologic outcome in the overall population (42 out of 151 patients [27.8%] v 2 out of 94 patients [2.12%], RD 0.22; 95% CI 0.13-0.31), and in OHCA patients (33 out of 121 patients [27.3%] v 2 out of 89 patients [2.25%] RD 0.21; 95% CI 0.11-0.30).ConclusionsA low rSO2 before starting ECPR could be a predictor of mortality and survival with poor neurologic outcomes.Copyright © 2023 Elsevier Inc. All rights reserved.

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