PMID- 33000057
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240329
IS  - 2688-1152 (Electronic)
IS  - 2688-1152 (Linking)
VI  - 1
IP  - 4
DP  - 2020 Aug
TI  - Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac 
      arrest: systematic review and meta-analysis of propensity score-matched cohort 
      studies.
PG  - 342-361
LID - 10.1002/emp2.12091 [doi]
AB  - INTRODUCTION: In this systematic review and meta-analysis of propensity 
      score-matched cohort studies, we quantitatively summarize whether venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO) used as extracorporeal 
      cardiopulmonary resuscitation (ECPR), compared with conventional cardiopulmonary 
      resuscitation (CCPR), is associated with improved rates of 30-day and long-term 
      favorable neurological outcomes and survival in patients resuscitated from in- 
      and out-of-hospital cardiac arrest. METHODS: We searched MEDLINE via PubMed, 
      Embase, Scopus, and Google Scholar for eligible studies on January 14, 2019. All 
      searches were limited to studies published between January 2000 and January 2019. 
      Two investigators independently evaluated the quality (or certainty) of evidence 
      according to GRADE guidelines. Pooled results are presented as relative risks 
      (RRs) with 95% confidence intervals (CIs). RESULTS: Six cohort studies using 
      propensity score-matched analysis were included, totaling 1108 matched patients. 
      Pooled analyses showed that ECPR was likely associated with improved 30-day and 
      long-term favorable neurological outcome in adults compared to CCPR for in- and 
      out-of-hospital cardiac arrest (RR = 2.02, 95% CI = 1.29-3.16; I(2) = 20%, P = 
      0.002; very low-quality evidence) and (RR = 2.86, 95% CI = 1.64-5.01; I(2) = 0%, 
      P = 0.0002; moderate-quality evidence), respectively. When we analyzed in- and 
      out-of-hospital cardiac arrest separately, ECPR was likely associated with 
      improved 30-day favorable neurological outcome compared to CCPR for in-hospital 
      cardiac arrest (RR = 2.18, 95% CI = 1.24-3.81; I(2) = 9%, P = 0.006; very 
      low-quality evidence), but not for out-of-hospital cardiac arrest (RR = 2.61, 95% 
      CI = 0.56-12.20; I(2) = 59%, P = 0.22; very low-quality evidence). ECPR was also 
      likely associated with improved long-term favorable neurological outcome compared 
      to CCPR for in-hospital cardiac arrest (RR = 2.50, 95% CI = 1.33-4.71; I(2) = 0%, 
      P = 0.005; moderate-quality evidence) and out-of-hospital cardiac arrest (RR = 
      4.64, 95% CI = 1.41-15.25; I(2) = 0%, P = 0.01; moderate-quality evidence). 
      CONCLUSIONS: Our analysis suggests that VA-ECMO used as ECPR may improve 
      long-term favorable neurological outcomes and survival when compared to the best 
      standard of care in a selected patient population. Therefore, it is imperative 
      for well-designed randomized clinical trials to obtain a higher level of 
      scientific evidence to ensure optimal outcomes for cardiac arrest patients.
CI  - (c) 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of 
      the American College of Emergency Physicians.
FAU - Miraglia, Dennis
AU  - Miraglia D
AUID- ORCID: 0000-0002-3887-3320
AD  - Department of Internal Medicine Good Samaritan Hospital Aguadilla Puerto Rico 
      USA.
FAU - Miguel, Lourdes A
AU  - Miguel LA
AD  - Department of Internal Medicine Good Samaritan Hospital Aguadilla Puerto Rico 
      USA.
FAU - Alonso, Wilfredo
AU  - Alonso W
AD  - Department of Internal Medicine Good Samaritan Hospital Aguadilla Puerto Rico 
      USA.
LA  - eng
PT  - Journal Article
DEP - 20200528
PL  - United States
TA  - J Am Coll Emerg Physicians Open
JT  - Journal of the American College of Emergency Physicians open
JID - 101764779
PMC - PMC7493557
OTO - NOTNLM
OT  - cardiopulmonary resuscitation
OT  - extracorporeal life support
OT  - extracorporeal membrane oxygenation
OT  - in-hospital cardiac arrest
OT  - out-of-hospital cardiac arrest
COIS- None.
EDAT- 2020/10/02 06:00
MHDA- 2020/10/02 06:01
PMCR- 2020/05/28
CRDT- 2020/10/01 05:39
PHST- 2019/12/11 00:00 [received]
PHST- 2020/03/25 00:00 [revised]
PHST- 2020/04/15 00:00 [accepted]
PHST- 2020/10/01 05:39 [entrez]
PHST- 2020/10/02 06:00 [pubmed]
PHST- 2020/10/02 06:01 [medline]
PHST- 2020/05/28 00:00 [pmc-release]
AID - EMP212091 [pii]
AID - 10.1002/emp2.12091 [doi]
PST - epublish
SO  - J Am Coll Emerg Physicians Open. 2020 May 28;1(4):342-361. doi: 
      10.1002/emp2.12091. eCollection 2020 Aug.