Brain Injury Brain Injury and Neurologic Outcome in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis: Erratum

Abstract BackgroundIn 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. MethodsWe performed a comprehensive systematic search of all studies up to December 20th 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. ResultsOur search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 31% (95% CI: 28-33%, I2=0%, p=0.26). In the surviving patients, the pooled percentage of favourable neurological outcome was 83% (95% CI: 79-87%, I2=24%, p=0.75). ConclusionECPR 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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Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

10.21203/rs.3.rs-16202/v3 ◽

2020 ◽

Author(s):

Benjamin Gravesteijn ◽

Marc Schluep ◽

Maksud Disli ◽

Prakriti Garkhail ◽

Dinis Dos Reis Miranda ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Fixed Effects ◽

Meta Analysis ◽

Favourable Outcome ◽

Secondary Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

Abstract 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 20th 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: CPR 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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Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/srep34208 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 31

Author(s):

Chiwon Ahn ◽

Wonhee Kim ◽

Youngsuk Cho ◽

Kyu-Sun Choi ◽

Bo-Hyoung Jang ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Meta Analysis ◽

Extracorporeal Cardiopulmonary Resuscitation

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Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis

Resuscitation ◽

10.1016/j.resuscitation.2016.12.011 ◽

2017 ◽

Vol 112 ◽

pp. 1-10 ◽

Cited By ~ 92

Author(s):

Guillaume Debaty ◽

Valentin Babaz ◽

Michel Durand ◽

Lucie Gaide-Chevronnay ◽

Emmanuel Fournel ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Prognostic Factors ◽

Cardiopulmonary Resuscitation ◽

Meta Analysis ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Refractory Cardiac Arrest

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Clinical Efficacy of Extracorporeal Cardiopulmonary Resuscitation for Adults with Cardiac Arrest: Meta-Analysis with Trial Sequential Analysis

BioMed Research International ◽

10.1155/2019/6414673 ◽

2019 ◽

Vol 2019 ◽

pp. 1-14 ◽

Cited By ~ 3

Author(s):

Zhen Chen ◽

Changzhi Liu ◽

Jiequn Huang ◽

Peiling Zeng ◽

Jingcheng Lin ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Clinical Efficacy ◽

Neurological Outcome ◽

Sequential Analysis ◽

Literature Search ◽

Meta Analysis ◽

Neurologic Outcome ◽

Trial Sequential Analysis ◽

Extracorporeal Cardiopulmonary Resuscitation

Objective. This meta-analysis with trial sequential analysis (TSA) compared the clinical efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) with conventional CPR (CCPR) for adult patients who experienced in-hospital cardiac arrest (IHCA) or out-of-hospital CA (OHCA). Methods. A literature search was used to identify eligible publications (up to 30 July 2018) from PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase. Two investigators independently conducted the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and TSA were used to analyze each outcome, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence. The primary outcome was 30-day survival, and the secondary outcomes were 30-day neurologic outcome, 3-6 months’ survival, 3-6 months’ neurological outcome, 1-year survival, and 1-year neurological outcome. Results. We identified 13 eligible observational studies for the final analysis. Pooled analyses showed that ECPR was associated with a significantly better 30-day survival (RR = 1.60, 95% CI = 1.25–2.06) and 30-day neurologic outcome (RR = 2.69, 95% CI = 1.63–4.46), and TSA confirmed these results. However, subgroup analysis of patients with OHCA indicated that ECPR and CCPR had similar effects on 30-day survival (RR = 1.18, 95% CI = 0.71–1.97), which was not confirmed by TSA. Analysis of OHCA patients indicated that ECPR provided a better 30-day neurological outcome (RR = 3.93, 95% CI = 1.00–15.50), but TSA did not support these results. Analysis of IHCA patients indicated that ECPR was associated with a better 30-day survival (RR 1.90, 95% CI 1.43–2.52) and 30-day neurologic outcome (RR 2.02, 95% CI 1.21–3.39), and TSA supported these results. Other subgroup analyses showed that the results were generally consistent, regardless of nation, propensity score matching, presumed etiology, whether the CA was witnessed or not, and study quality. Conclusions. Relative to CCPR, ECPR improved the survival and neurological outcome of patients who had IHCA. Compared to IHCA patients, TSA could not confirm better survival and neurologic outcome of ECPR in OHCA patients, suggesting that further studies are needed. Trial Registration. This trial was registered with PROSPERO (CRD42018100513) on 17 July 2018.

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