by Benjamin Yaël Gravesteijn, Marc Schluep, Maksud Disli,
Prakriti Garkhail, Dinis Dos Reis Miranda, Robert-Jan Stolker, Henrik Endeman
and Sanne Elisabeth Hoeks
Critical Care volume 24,
Article number: 505 (2020)
Background
In-hospital cardiac arrest (IHCA) is a major adverse event
with a high mortality rate if not treated appropriately. Extracorporeal
cardiopulmonary resuscitation (ECPR), as adjunct to conventional
cardiopulmonary resuscitation (CCPR), is a promising technique for IHCA
treatment. Evidence pertaining to neurological outcomes after ECPR is still
scarce.
Methods
We performed a comprehensive systematic search of all
studies up to December 20, 2019. Our primary outcome was neurological outcome
after ECPR at any moment after hospital discharge, defined by the Cerebral
Performance Category (CPC) score. A score of 1 or 2 was defined as favourable
outcome. Our secondary outcome was post-discharge mortality. A fixed-effects
meta-analysis was performed.
Results
Our search yielded 1215 results, of which 19 studies were
included in this systematic review. The average survival rate was 30% (95% CI
28–33%, I2 = 0%, p = 0.24). In the surviving patients, the
pooled percentage of favourable neurological outcome was 84% (95% CI
80–88%, I2 = 24%, p = 0.90).
Conclusion
ECPR as treatment for in-hospital cardiac arrest is
associated with a large proportion of patients with good neurological outcome.
The large proportion of favourable outcome could potentially be explained by the
selection of patients for treatment using ECPR. Moreover, survival is higher
than described in the conventional CPR literature. As indications for ECPR
might extend to older or more fragile patient populations in the future,
research should focus on increasing survival, while maintaining optimal
neurological outcome.
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