Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis

• Published in: Critical care (London, England) Vol. 28; no. 1; p. 57
• Main Authors: Low, Christopher Jer Wei, Ling, Ryan Ruiyang, Ramanathan, Kollengode, Chen, Ying, Rochwerg, Bram, Kitamura, Tetsuhisa, Iwami, Taku, Ong, Marcus Eng Hock, Okada, Yohei
• Format: Journal Article
• Language: English
• Published: London BioMed Central 21.02.2024; BioMed Central Ltd
• Subjects: Blood oxygenation, Extracorporeal; Brief Report; Cardiac arrest; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Care and treatment; Complications and side effects; CPR; CPR (First aid); Critical Care Medicine; Emergency Medicine; Extracorporeal Membrane Oxygenation - methods; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Intensive; Medical prognosis; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Patient outcomes; Patients; Sensitivity analysis; Systematic review; Singapore; Extracorporeal membrane oxygenation; Cardiopulmonary resuscitation; Cardiac arrest; Meta-analysis
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1466-609X; 1366-609X
• DOI: 10.1186/s13054-024-04830-5

Background Extracorporeal 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). Methods We 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. Results We 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. Conclusions We 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.