Holmberg, Mathias J., Geri, Guillaume, Wiberg, Sebastian, Guerguerian, Anne-Marie, Donnino, Michael W., Nolan, Jerry P., Deakin, Charles D. and Andersen, Lars W. (2018) Extracorporeal cardiopulmonary resuscitation for cardiac arrest : a systematic review. Resuscitation, 131 . pp. 91-100. doi:10.1016/j.resuscitation.2018.07.029

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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.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	CPR (First aid), Cardiac arrest -- Treatment, Cardiac resuscitation
Journal or Publication Title:	Resuscitation
Publisher:	Elsevier Ireland Ltd
ISSN:	0300-9572
Official Date:	October 2018
Dates:	Date Event October 2018 Published 29 July 2018 Available 25 July 2018 Accepted
Date of first compliant deposit:	5 February 2019
Volume:	131
Page Range:	pp. 91-100
DOI:	10.1016/j.resuscitation.2018.07.029
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED International Liaison Committee on Resuscitation http://viaf.org/viaf/128758637 K24HL127101 National Heart, Lung, and Blood Institute http://dx.doi.org/10.13039/100000050 R01HL136705 National Heart, Lung, and Blood Institute http://dx.doi.org/10.13039/100000050

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