• Christopher Jer Wei Low, Ryan Ruiyang Ling, Kollengode Ramanathan, Ying Chen, Bram Rochwerg, Tetsuhisa Kitamura, Taku Iwami, OngMarcus Eng HockMEHHealth Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore., and Yohei Okada.
• Yong Loo Lin School of Medicine, National University of Singapore, National Unviersity Health System, Singapore, Singapore.
• Crit Care. 2024 Feb 21; 28 (1): 5757.

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) may reduce mortality and improve neurological outcomes in patients with cardiac arrest. We updated our existing meta-analysis and trial sequential analysis to further evaluate ECPR compared to conventional CPR (CCPR).MethodsWe searched three international databases from 1 January 2000 through 1 November 2023, for randomised controlled trials or propensity score matched studies (PSMs) comparing ECPR to CCPR in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). We conducted an updated random-effects meta-analysis, with the primary outcome being in-hospital mortality. Secondary outcomes included short- and long-term favourable neurological outcome and survival (30 days-1 year). We also conducted a trial sequential analysis to evaluate the required information size in the meta-analysis to detect a clinically relevant reduction in mortality.ResultsWe included 13 studies with 14 pairwise comparisons (6336 ECPR and 7712 CCPR) in our updated meta-analysis. ECPR was associated with greater precision in reducing overall in-hospital mortality (OR 0.63, 95% CI 0.50-0.79, high certainty), to which the trial sequential analysis was concordant. The addition of recent studies revealed a newly significant decrease in mortality in OHCA (OR 0.62, 95% CI 0.45-0.84). Re-analysis of relevant secondary outcomes reaffirmed our initial findings of favourable short-term neurological outcomes and survival up to 30 days. Estimates for long-term neurological outcome and 90-day-1-year survival remained unchanged.ConclusionsWe found that ECPR reduces in-hospital mortality, improves neurological outcome, and 30-day survival. We additionally found a newly significant benefit in OHCA, suggesting that ECPR may be considered in both IHCA and OHCA.© 2024. The Author(s).

19 keywords...

hide…