Objectives
To evaluate the available published evidence of the effects of extracorporeal cardiopulmonary
resuscitation (ECPR) in the prehospital setting on clinical outcomes in patients with
out-of-hospital cardiac arrest.
Design
A systematic review and meta-analysis designed according to the Preferred Reporting
Items for Systematic Reviews an Meta-Analyses guidelines.
Setting
In the prehospital setting.
Participants
All randomized control trials (RCTs) and observational trials using pre-hospital ECPR
in adult patients (>17 years).
Interventions
Prehospital ECPR.
Measurements and Main Results
The study authors searched Medline, Embase, and PUBMED for all RCTs and observational
trials. The studies were assessed for clinical, methodologic, and statistical heterogeneity.
The primary outcome was survival at hospital discharge. The study outcomes were aggregated
using random-effects meta-analysis of means or proportions as appropriate. The Grading
of Recommendations Assessment, Development and Evaluation methodology was used to
assess the quality of evidence. Four studies were included, with a total of 222 patients
receiving prehospital ECPR (mean age = 51 years [95% CI 44-57], 81% of patients were
male (CI 74-87), and 60% patients had a cardiac cause for their arrest (95% CI 43-76).
Overall survival at discharge was 23.4% (95% CI 15.5-33.7; I2 = 62%). The pooled low-flow time was 61.1 minutes (95% CI 45.2-77.0; I2 = 97%). The quality of evidence was assessed to be low, and the overall risk of bias
was assessed to be serious, with confounding being the primary source of bias.
Conclusion
No definitive conclusions can be made as to the efficacy of prehospital ECPR in refractory
cardiac arrest. Higher quality evidence is required.
Key Words
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Article info
Publication history
Published online: December 15, 2022
Publication stage
In Press Corrected ProofFootnotes
Dr Dennis is supported by a Post-Doctoral Scholarship (Ref: 105849) from the National Heart Foundation of Australia. The National Heart Foundation had no role in the study design, collection, analysis, or interpretation of the data nor in writing of the data and submission of the article. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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© 2022 Elsevier Inc. All rights reserved.
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- Extracorporeal cardiopulmonary resuscitation: pre-hospital or in-hospital cannulation?Journal of Cardiothoracic and Vascular Anesthesia
- PreviewExtracorporeal cardiopulmonary resuscitation (E-CPR) is the establishment of veno-arterial extracorporeal membrane oxygenation (ECMO) during ongoing cardiopulmonary resuscitation (CPR). E-CPR is the last rescue therapy when, despite high-quality conventional CPR, it is not possible to achieve the return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). The probability of achieving ROSC and survival declines rapidly after ten minutes of resuscitation [1,2] and less than 1% of patients survive with a favorable neurological outcome after 35 minutes of conventional CPR [2].
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