Mathias J Holmberg1, Guillaume Geri2, Sebastian Wiberg3, Anne-Marie Guerguerian4, Michael W Donnino5, Jerry P Nolan6, Charles D Deakin7, Lars W Andersen8. 1. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Bygning J, Plan 1, 8200 Aarhus N, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA. 2. Medical Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Ambroise Paré Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Versailles Saint Quentin University, INSERM UMR1018, Team 5 Kidney & Heart, 78000 Versailles, France. 3. Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. 4. Department of Critical Care Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada. 5. Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA. 6. Bristol Medical School, University of Bristol, 69 St Michael's Hill, Bristol BS2 8DZ, UK. 7. NIHR Southampton Respiratory Biomedical Research Unit, Southampton, SO16 6YD, UK. 8. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Bygning J, Plan 1, 8200 Aarhus N, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA. Electronic address: lwandersen@clin.au.dk.
Abstract
AIM: To assess the use of extracorporeal cardiopulmonary resuscitation (ECPR), compared with manual or mechanical cardiopulmonary resuscitation (CPR), for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in adults and children. METHODS: The PRISMA guidelines were followed. We searched Medline, Embase, and Evidence-Based Medicine Reviews for randomized clinical trials and observational studies published before May 22, 2018. The population included adult and pediatric patients with OHCA and IHCA of any origin. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the ROBINS-I tool. Outcomes included short-term and long-term survival and favorable neurological outcome. RESULTS: We included 25 observational studies, of which 15 studies were in adult OHCA, 7 studies were in adult IHCA, and 3 studies were in pediatric IHCA. There were no studies in pediatric OHCA. No randomized trials were included. Results from individual studies were largely inconsistent, although several studies in adult and pediatric IHCA were in favor of ECPR. The risk of bias for individual studies was overall assessed to be critical, with confounding being the primary source of bias. The overall quality of evidence was assessed to be very low. Heterogeneity across studies precluded any meaningful meta-analyses. CONCLUSIONS: There is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies is very low.
AIM: To assess the use of extracorporeal cardiopulmonary resuscitation (ECPR), compared with manual or mechanical cardiopulmonary resuscitation (CPR), for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in adults and children. METHODS: The PRISMA guidelines were followed. We searched Medline, Embase, and Evidence-Based Medicine Reviews for randomized clinical trials and observational studies published before May 22, 2018. The population included adult and pediatric patients with OHCA and IHCA of any origin. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the ROBINS-I tool. Outcomes included short-term and long-term survival and favorable neurological outcome. RESULTS: We included 25 observational studies, of which 15 studies were in adult OHCA, 7 studies were in adult IHCA, and 3 studies were in pediatric IHCA. There were no studies in pediatric OHCA. No randomized trials were included. Results from individual studies were largely inconsistent, although several studies in adult and pediatric IHCA were in favor of ECPR. The risk of bias for individual studies was overall assessed to be critical, with confounding being the primary source of bias. The overall quality of evidence was assessed to be very low. Heterogeneity across studies precluded any meaningful meta-analyses. CONCLUSIONS: There is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies is very low.
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