Extracorporeal vs. conventional CPR for out-of-hospital cardiac arrest: A systematic review and meta-analysis

作者：Jingyi Wang, Yan Chen, Run Dong, Shan Li, Jinmin Peng, Xiao-yun Hu, Wei Jiang, Chunyao Wang, Li Weng, Bin Du · 发表于：The American Journal of Emergency Medicine · 年份：2024 · DOI：10.1016/j.ajem.2024.04.002 · 被引用次数：14 · 研究领域：Mechanical Circulatory Support Devices、Cardiac Arrest and Resuscitation、Respiratory Support and Mechanisms

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality and morbidity worldwide. Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential intervention for OHCA, but its effectiveness compared to conventional cardiopulmonary resuscitation (CCPR) needs further evaluation. METHOD: We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from January 2010 to March 2023. Pooled meta-analysis was performed to investigate any potential association between ECPR and improved survival and neurological outcomes. RESULTS: This systematic review and meta-analysis included two randomized controlled trials enrolling 162 participants and 10 observational cohort studies enrolling 4507 participants. The pooled meta-analysis demonstrated that compared to CCRP, ECPR did not improve survival and neurological outcomes at 180 days following OHCA (RR: 3.39, 95% CI: 0.79 to 14.64; RR: 2.35, 95% CI: 0.97 to 5.67). While a beneficial effect of ECPR was obtained regarding 30-day survival and neurological outcomes. Furthermore, ECPR was associated with a higher risk of bleeding complications. Subgroup analysis showed that ECPR was prominently beneficial when exclusively initiated in the emergency department. Additional post-resuscitation treatments did not significantly impact the efficacy of ECPR on 180-day survival with favorable neurological outcomes. CONCLUSIONS: There is no high-quality e...