Extracorporeal membrane oxygenation-facilitated resuscitation in out-of-hospital cardiac arrest: a meta-analysis of randomized controlled trials

AimsIt remains unclear whether extracorporeal cardiopulmonary resuscitation (ECPR) could improve neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) compared with conventional cardiopulmonary resuscitation (CCPR).MethodsWe conducted a systemic search for randomized controlled trials (RCTs) comparing the efficacy of ECPR versus CCPR for OHCA until February 2023. The main end points were 6-month survival, and 6-month and short-term (in-hospital or 30-day) survival with favorable neurological outcome, defined as a Glasgow-Pittsburg cerebral performance category (CPC) score of 1 or 2.ResultsWe identified four RCTs including a total of 435 patients. In the included RCTs, the initial cardiac rhythms were ventricular fibrillation in most cases (75%). There was a tendency towards improved 6-month survival and 6-month survival with favorable neurological outcome in ECPR although it did not reach statistical significance [odds ratio (OR): 1.50; 95% confidence interval (CI): 0.67 to 3.36, I-2 = 50%, and OR: 1.74; 95% CI: 0.86 to 3.51, I-2 = 35%, respectively]. ECPR was associated with a significant improvement in short-term favorable neurological outcomes without heterogeneity (OR: 1.84; 95% CI: 1.14 to 2.99, I-2 = 0%).ConclusionOur meta-analysis of RCTs revealed that there was a tendency towards better mid-term neurological outcomes in ECPR and that ECPR was associated with a significant improvement in short-term favorable neurological outcomes compared with CCPR.

Automated summary

The meta-analysis of randomized controlled trials showed that extracorporeal cardiopulmonary resuscitation (ECPR) may have a tendency towards better mid-term neurological outcomes and was associated with a significant improvement in short-term favorable neurological outcomes compared with conventional cardiopulmonary resuscitation (CCPR).