Abstract
BackgroundThe use of extracorporeal membrane oxygenation (ECMO) during cardiac arrest (ECPR) has increased exponentially. However, reported outcomes vary considerably due to differing study designs and selection criteria. This review assessed the impact of pre-defined selection criteria on ECPR survival.MethodsSystematic review applying PRISMA guidelines. We searched Medline, Embase, and Evidence-Based Medicine Reviews for RCTs and observational studies published from January 2000 to June 2021. Adult patients (> 12 years) receiving ECPR were included. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Outcomes included overall and neurologically favourable survival. Meta-analysis and meta-regression were performed.Results67 studies were included: 14 prospective and 53 retrospective. No RCTs were identified at time of search. The number of inclusion criteria to select ECPR patients (p = 0.292) and study design (p = 0.962) was not associated with higher favourable neurological survival. However, amongst prospective studies, increased number of inclusion criteria was associated with improved outcomes in both OHCA and IHCA cohorts. (β = 0.12, p = 0.026) and arrest to ECMO flow time was predictive of survival. (β = -0.023, p < 0.001).ConclusionsProspective studies showed number of selection criteria and, in particular, arrest to ECMO time were associated with significant improved survival. Well-designed prospective studies assessing the relative importance of criteria as well as larger efficacy studies are required to ensure appropriate application of what is a costly intervention.
Highlights
The use of extracorporeal membrane oxygenation (ECMO) during cardiac arrest (ECPR) has increased exponentially
No randomised clinical trials were identified during the search. 67 observational studies (14 prospective and 53 retrospective studies) met all the inclusion criteria and none of the exclusion criteria
We performed a comprehensive systematic review and meta-analysis of ECPR studies to assess the impact of study design and the number of inclusion criteria on outcome with additional sensitivity analyses of individual inclusion criteria on outcome
Summary
The use of extracorporeal membrane oxygenation (ECMO) during cardiac arrest (ECPR) has increased exponentially. Reported outcomes vary considerably due to differing study designs and selection criteria. Extracorporeal membrane oxygenation (ECMO) for refractory cardiac arrest (RCA, ECPR) provides adequate systemic perfusion while the underlying cause may be diagnosed and treated. Whilst promising outcomes have been reported [1,2,3], survival rates vary widely [3] which is likely due to differences in study design, geographical. A few well designed prospective studies exist [4], the use of ECPR has increased exponentially over the past decade [5]. Its cost-effectiveness is dependent on survival outcomes, which are influenced by inclusion criteria [9]. Current patient selection criteria for ECPR has largely been empirically determined [10]
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