A Comparison between Conventional and Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Authors

Reem Alfalasi, Department of Critical Care Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY 10032, USA.
Jessica Downing, Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Stephanie Cardona, Department of Critical Care Medicine, Mount Sinai Hospital, New York, NY 10029, USA.
Bobbi-Jo Lowie, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Matthew Fairchild, Research Associate Program in Emergency and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Caleb Chan, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Elizabeth Powell, Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Ali Pourmand, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA.
Alison Grazioli, Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Quincy K. Tran, Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Document Type

Journal Article

Publication Date

3-21-2022

Journal

Healthcare (Basel, Switzerland)

Volume

10

Issue

3

DOI

10.3390/healthcare10030591

Keywords

ECMO; OHCA; VA ECMO; extracorporeal membrane oxygenation; neurologic outcome; out-of-hospital cardiac arrest; survival to discharge

Abstract

There is limited evidence comparing the use of extracorporeal cardiopulmonary resuscitation (ECPR) to CPR in the management of refractory out-of-hospital cardiac arrest (OHCA). We conducted a systematic review and meta-analysis to compare survival and neurologic outcomes associated with ECPR versus CPR in the management of OHCA. We searched PubMed, EMBASE, and Scopus to identify observational studies and randomized controlled trials comparing ECPR and CPR. We used the Newcastle-Ottawa Scale and Cochrane's risk-of-bias tool to assess studies' quality. We used random-effects models to compare outcomes between the pooled populations and moderator analysis to identify sources of heterogeneity and perform subgroup analysis. We identified 2088 articles and included 13, with 18,620 patients with OHCA. A total of 16,701 received CPR and 1919 received ECPR. Compared with CPR, ECPR was associated with higher odds of achieving favorable neurologic outcomes at 3 (OR 5, 95% CI 1.90-13.1, < 0.01) and 6 months (OR 4.44, 95% CI 2.3-8.5, < 0.01). We did not find a significant survival benefit or impact on neurologic outcomes at hospital discharge or 1 month following arrest. ECPR is a promising but resource-intensive intervention with the potential to improve long-term outcomes among patients with OHCA.

APA Citation

Alfalasi, Reem; Downing, Jessica; Cardona, Stephanie; Lowie, Bobbi-Jo; Fairchild, Matthew; Chan, Caleb; Powell, Elizabeth; Pourmand, Ali; Grazioli, Alison; and Tran, Quincy K., "A Comparison between Conventional and Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis" (2022). GW Authored Works. Paper 564.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/564

Department

Emergency Medicine