Extracorporeal cardiopulmonary resuscitation for cardiac arrest: An updated systematic review

Mathias J Holmberg; Asger Granfeldt; Anne-Marie Guerguerian; Claudio Sandroni; Cindy H Hsu; Ryan M Gardner; Peter C Lind; Mark A Eggertsen; Cecilie M Johannsen; Lars W Andersen

doi:10.1016/j.resuscitation.2022.12.003

Extracorporeal cardiopulmonary resuscitation for cardiac arrest: An updated systematic review

Resuscitation. 2023 Jan:182:109665. doi: 10.1016/j.resuscitation.2022.12.003. Epub 2022 Dec 12.

Authors

Affiliations

¹ Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: mathias.holmberg@clin.au.dk.
² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
³ Department of Critical Care Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, ON, Canada.
⁴ Department of Intensive Care Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.
⁵ Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, USA.
⁶ Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁷ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁸ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Denmark.

PMID: 36521684
DOI: 10.1016/j.resuscitation.2022.12.003

Abstract

Objectives: To provide an updated systematic review on the use of extracorporeal cardiopulmonary resuscitation (ECPR) compared with manual or mechanical cardiopulmonary resuscitation during cardiac arrest.

Methods: This was an update of a systematic review published in 2018. OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized trials and observational studies between January 1, 2018, and June 21, 2022. The population included adults and children with out-of-hospital or in-hospital cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed bias. The certainty of evidence was evaluated using GRADE.

Results: The search identified 3 trials, 27 observational studies, and 6 cost-effectiveness studies. All trials included adults with out-of-hospital cardiac arrest and were terminated before enrolling the intended number of subjects. One trial found a benefit of ECPR in survival and favorable neurological status, whereas two trials found no statistically significant differences in outcomes. There were 23 observational studies in adults with out-of-hospital cardiac arrest or in combination with in-hospital cardiac arrest, and 4 observational studies in children with in-hospital cardiac arrest. Results of individual studies were inconsistent, although many studies favored ECPR. The risk of bias was intermediate for trials and critical for observational studies. The certainty of evidence was very low to low. Study heterogeneity precluded meta-analyses. The cost-effectiveness varied depending on the setting and the analysis assumptions.

Conclusions: Recent randomized trials suggest potential benefit of ECPR, but the certainty of evidence remains low. It is unclear which patients might benefit from ECPR.

Keywords: Cardiac Arrest; Cardiopulmonary Bypass; Cardiopulmonary Resuscitation; Extracorporeal Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation.

Publication types

Systematic Review
Review

MeSH terms

Adult
Cardiopulmonary Resuscitation* / methods
Child
Extracorporeal Membrane Oxygenation* / methods
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Retrospective Studies