Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

doi:10.5847/wjem.j.1920-8642.2017.01.001

Abstract

Abstract:

BACKGROUND: This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients with cardiac arrest (CA).

DATA RESOURCES: PubMed, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data (survival, good neurological outcome at discharge, at 3-6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Review Manager 5.3.

RESULTS: In six studies 2 260 patients were enrolled to study the survival rate to discharge and long-term neurological outcome published since 2000. A significant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients (RR 2.37, 95%CI 1.63-3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR (RR 2.79, 95%CI 1.96-3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients (RR 2.69, 95%CI 1.48-4.91, P=0.001). However, no significant difference was found in IHCA patients (RR 1.84, 95%CI 0.91-3.73, P=0.09).

CONCLUSION: ECPR showed a beneficial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA.

Key words: Extracorporeal cardiopulmonary resuscitation, Cardiac arrest, Adult, Outcome, Meta-analysis

Gan-nan Wang, Xu-feng Chen, Li Qiao, Yong Mei, Jin-ru Lv, Xi-hua Huang, Bin Shen, Jin-song Zhang. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest[J]. World Journal of Emergency Medicine, 2017, 8(1): 5-11.

Figures/Tables 6

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References 23

1	Zhao Y, Xing J, Du Z, Liu F, Jia M, Hou X. Extracorporeal cardiopulmonary resuscitation for adult patients who underwent post-cardiac surgery. Eur J Med Res. 2015; 20:83. doi: 10.1186/s40001-015-0179-4 pmid: 26459158
2	Blewer AL, Buckler DG, Li J, Leary M, Becker LB, Shea JA, et al. Impact of the 2010 resuscitation guidelines training on layperson chest compressions. World J Emerg Med. 2015; 6(4):270-6. doi: 10.5847/wjem.j.1920-8642.2015.04.004 pmid: 26693261
3	Fagnoul D, Combes A, De Backer D. Extracorporeal cardiopulmonary resuscitation. Curr Opin Crit Care. 2014; 20(3):259-65. doi: 10.1097/MCC.0000000000000098 pmid: 24785674
4	Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013; 128(4):417-35. pmid: 23801105
5	Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015; 86:88-94. doi: 10.1016/j.resuscitation.2014.09.010 pmid: 25281189
6	Mochizuki K, Imamura H, Iwashita T, Okamoto K. Neurological outcomes after extracorporeal cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest: a retrospective observational study in a rural tertiary care center. J Intensive Care. 2014; 2(1):33. doi: 10.1186/2052-0492-2-33 pmid: 25908986
7	Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008; 372(9638):554-61. doi: 10.1016/S0140-6736(08)60958-7 pmid: 18603291
8	Shin TG, Choi JH, Jo IJ, Sim MS, Song HG, Jeong YK, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation. Crit Care Med. 2011; 39(1):1-7. doi: 10.1097/CCM.0b013e3181feb339 pmid: 21057309
9	Maekawa K, Tanno K, Hase M, Mori K, Asai Y. Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis. Crit Care Med. 2013; 41(5):1186-96. doi: 10.1097/CCM.0b013e31827ca4c8 pmid: 23388518
10	Chou TH, Fang CC, Yen ZS, Lee CC, Chen YS, Ko WJ, et al. An observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction. Emerg Med J. 2014; 31(6):441-7. doi: 10.1136/emermed-2012-202173 pmid: 24107999
11	Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study. Crit Care. 2014; 18(5):535. pmid: 25255842
12	Lee SH, Jung JS, Lee KH, Kim HJ, Son HS, Sun K. Comparison of Extracorporeal Cardiopulmonary Resuscitation with Conventional Cardiopulmonary Resuscitation: Is Extracorporeal Cardiopulmonary Resuscitation Beneficial? Korean J Thorac Cardiovasc Surg. 2015; 48(5):318-27. doi: 10.5090/kjtcs.2015.48.5.318 pmid: 26509125
13	Brooks SC, Anderson ML, Bruder E, Daya MR, Gaffney A, Otto CW, et al. Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S436-43. pmid: 26472994
14	Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. pmid: 12958120
15	Mosier JM, Kelsey M, Raz Y, Gunnerson KJ, Meyer R, Hypes CD, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care. 2015; 19:431. doi: 10.1186/s13054-015-1155-7 pmid: 26672979
16	Blumenstein J, Leick J, Liebetrau C, Kempfert J, Gaede L, Groß S, et al. Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: A propensity-matched analysis. Eur Heart J Acute Cardiovasc Care. 2015 Oct 26. pii: 2048872615612454. [Epub ahead of print] doi: 10.1177/2048872620936371 pmid: 32597679
17	Wang J, Zhuo CN, Zhang L, Gong YS, Yin CL, Li YQ. Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study. World J Emerg Med. 2015; 6(3):179-85. doi: 10.5847/wjem.j.1920-8642.2015.03.003 pmid: 26401177
18	Paden ML, Conrad SA, Rycus PT, Thiagarajan RR. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J. 2013; 59(3):202-10. doi: 10.1097/MAT.0b013e3182904a52 pmid: 23644605
19	Cardarelli MG, Young AJ, Griffith B. Use of extracorporeal membrane oxygenation for adults in cardiac arrest (E-CPR): a meta-analysis of observational studies. ASAIO J. 2009; 55(6):581-6. doi: 10.1097/MAT.0b013e3181bad907 pmid: 19770800
20	Jung C, Janssen K, Kaluza M, Fuernau G, Poerner TC, Fritzenwanger M, et al. Outcome predictors in cardiopulmonary resuscitation facilitated by extracorporeal membrane oxygenation. Clin Res Cardiol. 2016; 105(3):196-205. pmid: 26303097
21	Haneya A, Philipp A, Diez C, Schopka S, Bein T, Zimmermann M, et al. A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest. Resuscitation. 2012; 83(11):1331-7. doi: 10.1016/j.resuscitation.2012.07.009 pmid: 22819880
22	Ryu JA, Cho YH, Sung K, Choi SH, Yang JH, Choi JH, et al. Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation. BMC Anesthesiol. 2015; 15:26. doi: 10.1186/s12871-015-0002-3 pmid: 25774089
23	Wang CH, Chou NK, Becker LB, Lin JW, Yu HY, Chi NH, et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest—a comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation. 2014; 85(9):1219-24. doi: 10.1016/j.resuscitation.2014.06.022 pmid: 24992872

First author, year	Country	Study period	NOS grade	Location of CA	ECPR group				CCPR group
First author, year	Country	Study period	NOS grade	Location of CA	Survival to discharge (%)	CPR duration (min)	Etiology C/N	Initial rhythm S/N	Survival to discharge (%)	CPR duration (min)	Etiology C/N	Initial rhythm S/N
Chen YS, 2008	China	2004-2006	8	IHCA	23.7	52.8±37.2	55/4	29/30	10.6	42.7±31.1	100/13	36/77
Shin TG, 2011	Korea	2003-2009	7	IHCA	28.2	42.1±25.7	75/10	25/60	7.8	41.3±36.7	256/65	73/248
Maekawa K, 2013	Japan	2000-2004	7	OHCA	32.1	49 (41-59)	—	32/21	6.4	56 (47-66)	—	24/85
Chou TH, 2014	China	2006-2010	7	IHCA	34.9	59.7±34.1	—	26/17	21.7	49.4±34.6	—	9/14
Kim SJ, 2014	Korea	2006-2013	7	OHCA	14.5	Pre-hospital 13 (7-17) In-hospital 47 (35-80)	49/6	31/24	8.1	Pre-hospital 13 (8-17) In-hospital 21 (8-35)	277/167	85/359
Lee SH, 2015	Korea	2009-2014	7	Mixed	22.2	43 (21-60)	69/1	34/38	13.7	30 (15-48)	418/11	129/704

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