PMID- 34223320
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220424
IS  - 2666-5204 (Electronic)
IS  - 2666-5204 (Linking)
VI  - 4
DP  - 2020 Dec
TI  - Long-term neurologically intact survival after extracorporeal cardiopulmonary 
      resuscitation for in-hospital or out-of-hospital cardiac arrest: A systematic 
      review and meta-analysis.
PG  - 100045
LID - 10.1016/j.resplu.2020.100045 [doi]
LID - 100045
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been 
      used as extracorporeal cardiopulmonary resuscitation (ECPR) to support further 
      resuscitation efforts in patients with cardiac arrest, yet its clinical 
      effectiveness remains uncertain. OBJECTIVES: This study reviews the role of ECPR 
      in contemporary resuscitation care compared to no ECPR and/or standard care, e.g. 
      conventional CPR, and quantitatively summarize the rates of long-term 
      neurologically intact survival after adult in-hospital cardiac arrest (IHCA) or 
      out-of-hospital cardiac arrest (OHCA). METHODS: We searched the following 
      databases on January 31 st, 2020: CENTRAL, MEDLINE, Embase, and Web of Science. 
      We followed PRISMA guidelines and used PICO format to summarize the research 
      questions. Risk of bias was assessed using the ROBINS-I tool. Pooled risk ratios 
      (RRs) for each outcome of interest were calculated. Quality of evidence was 
      evaluated according to GRADE guidelines. RESULTS: Six cohort studies were 
      included, totaling 1750 patients. Of these, 530 (30.3%) received the 
      intervention, and 91 (17.2%) survived with long-term neurologically intact 
      survival. ECPR compared to no ECPR is likely associated with improved long-term 
      neurologically intact survival after cardiac arrest in any setting (risk ratio 
      [RR] 3.11, 95% confidence interval [CI] 2.06-4.69; p < 0.00001) (GRADE: Very low 
      quality). Similar results were found for long-term neurologically intact survival 
      after IHCA (RR 3.21, 95% CI 1.74-5.94; p < 0.0002) (GRADE: Very low quality) and 
      OHCA (RR 3.11, 95% CI 1.50-6.47; p < 0.002) (GRADE: Very low quality). Long-term 
      time frames for neurologically intact survival (three months to two years) were 
      combined into a single category, defined a priori as a Glasgow-Pittsburgh 
      cerebral performance category (CPC) of 1 or 2. CONCLUSIONS: VA-ECMO used as ECPR 
      is likely associated with improved long-term neurologically intact survival after 
      cardiac arrest. Future evidence from randomized trials is very likely to have an 
      important impact on the estimated effect of this intervention and will further 
      define optimal clinical practice. Review registration: PROSPERO CRD42020171945.
CI  - (c) 2020 The Author(s).
FAU - Miraglia, Dennis
AU  - Miraglia D
AD  - Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United 
      States.
FAU - Miguel, Lourdes A
AU  - Miguel LA
AD  - Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United 
      States.
FAU - Alonso, Wilfredo
AU  - Alonso W
AD  - Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United 
      States.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20201211
PL  - Netherlands
TA  - Resusc Plus
JT  - Resuscitation plus
JID - 101774410
PMC - PMC8244502
OTO - NOTNLM
OT  - Cardiac arrest
OT  - ECPR
OT  - Extracorporeal cardiopulmonary resuscitation
OT  - Extracorporeal life support
EDAT- 2021/07/06 06:00
MHDA- 2021/07/06 06:01
PMCR- 2020/12/11
CRDT- 2021/07/05 10:24
PHST- 2020/07/15 00:00 [received]
PHST- 2020/10/15 00:00 [revised]
PHST- 2020/10/20 00:00 [accepted]
PHST- 2021/07/05 10:24 [entrez]
PHST- 2021/07/06 06:00 [pubmed]
PHST- 2021/07/06 06:01 [medline]
PHST- 2020/12/11 00:00 [pmc-release]
AID - S2666-5204(20)30045-X [pii]
AID - 100045 [pii]
AID - 10.1016/j.resplu.2020.100045 [doi]
PST - epublish
SO  - Resusc Plus. 2020 Dec 11;4:100045. doi: 10.1016/j.resplu.2020.100045. eCollection 
      2020 Dec.