Extracorporeal membrane oxygenation-facilitated resuscitation in out-of-hospital cardiac arrest: a meta-analysis of randomized controlled trials

Abstract

Aims It remains unclear whether extracorporeal cardiopulmonary resuscitation (ECPR) could improve neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) compared with conventional cardiopulmonary resuscitation (CCPR). Methods We conducted a systemic search for randomized controlled trials (RCTs) comparing the efficacy of ECPR versus CCPR for OHCA until February 2023. The main end points were 6-month survival, and 6-month and short-term (in-hospital or 30-day) survival with favorable neurological outcome, defined as a Glasgow–Pittsburg cerebral performance category (CPC) score of 1 or 2. Results We identified four RCTs including a total of 435 patients. In the included RCTs, the initial cardiac rhythms were ventricular fibrillation in most cases (75%). There was a tendency towards improved 6-month survival and 6-month survival with favorable neurological outcome in ECPR although it did not reach statistical significance [odds ratio (OR): 1.50; 95% confidence interval (CI): 0.67 to 3.36, I 2  = 50%, and OR: 1.74; 95% CI: 0.86 to 3.51, I 2  = 35%, respectively]. ECPR was associated with a significant improvement in short-term favorable neurological outcomes without heterogeneity (OR: 1.84; 95% CI: 1.14 to 2.99, I 2  = 0%). Conclusion Our meta-analysis of RCTs revealed that there was a tendency towards better mid-term neurological outcomes in ECPR and that ECPR was associated with a significant improvement in short-term favorable neurological outcomes compared with CCPR.