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.
Keywords
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Article info
Publication history
Published online: July 28, 2018
Accepted:
July 25,
2018
Received in revised form:
July 19,
2018
Received:
June 21,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.