ECPR for cardiac arrest: evidence remains unclear

  • Holmberg MJ & al.
  • Resuscitation
  • 28 Jul 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • It remains unclear whether extracorporeal CPR (ECPR) is associated with better outcomes vs CPR for out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA).

Why this matters

  • ECPR is recognized as an option for some cardiac arrest (CA) patients by the American Heart Association and European Resuscitation Council.
  • However, optimal candidates and therapeutic benefits, if any, are unclear.

Key results

  • Meta-analysis was not feasible because of heterogeneity.
  • There was critical bias risk, especially from confounding, in all studies.
  • Quality of evidence deemed very low.
  • OHCA: 
    • Adults: forest plots favored ECPR for long-term survival and favorable neurological outcomes.
  • IHCA: 
    • Adults: forest plots favored ECPR for survival to discharge, long-term survival, and favorable neurological outcomes;
    • Children: forest plots generally favored ECPR for survival to discharge;
    • Children: 1 study favored ECPR for favorable neurological outcome.

Study design

  • Systematic review of 25 observational studies comparing ECPR with CPR in adults and children who experienced CA.
  • Results to inform International Liaison Committee on Resuscitation recommendations.
  • Outcomes included survival and favorable neurological outcome.
  • Funding: None disclosed.

Limitations

  • No randomized controlled trials found.
  • No studies of pediatric OHCA.
  • Many studies did not adjust results for confounders.

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