Abstract 243: Comparing the Effectiveness of Extracorporeal and Conventional Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: An Updated Systematic Review and Meta-Analysis

Abstract

Background: Cardiac arrest is a leading cause of death worldwide, with out-of-hospital cardiac arrest (OHCA) presenting unique challenges in terms of timely and effective treatment. Conventional Cardiopulmonary Resuscitation (CPR) remains the standard intervention; however, the emerging use of Extracorporeal Cardiopulmonary Resuscitation (ECPR) and its potential for superior hemodynamic support necessitates a comprehensive comparison of these interventions in the context of OHCA to guide resuscitation practices. Aim: This study aims to compare ECPR and conventional CPR in patients experiencing OHCA. Methods: We searched several databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) until May 2023. Studies that compared ECPR and conventional CPR in OHCA were included in the analysis. The outcomes assessed included in-hospital mortality following admission, return of spontaneous circulation (ROSC), 30-day mortality, and positive neurological recovery at discharge. Data analysis was performed using a random-effects model, with Relative Risk (RR) computed for each outcome. All statistical analyses were performed using R software (version 4.0.3) with metafor and meta packages. Results: We included a total of 5 studies totaling 8,632 patients (4,315 in the ECPR group and 4,317 in the conventional CPR group). The analysis revealed no significant difference between ECPR and conventional CPR in terms of in-hospital mortality (RR 0.95, 95% Confidence Interval (CI) 0.88 to 1.03, P=0.19, I2=60%) and ROSC (RR 1.01, 95% CI 0.97 to 1.05, P=0.58, I2=0%). However, ECPR was associated with a significant reduction in 30-day mortality (RR 0.93, 95% CI 0.91 to 0.95, P<0.01, I2=0%). No significant improvement was found in positive neurological recovery at discharge with ECPR compared to conventional CPR (RR 1.25, 95% CI 0.80 to 1.93, P=0.33, I2=16%). Conclusion: This study highlights the potential of ECPR in reducing 30-day mortality compared to conventional CPR in OHCA cases, although its effectiveness in other outcomes, such as in-hospital mortality and neurological recovery, remains inconclusive. Given the observed heterogeneity among the studies, further high-quality studies are needed.