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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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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