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Meta-Analysis
. 2020 Aug 17;24(1):505.
doi: 10.1186/s13054-020-03201-0.

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Benjamin Yaël Gravesteijn  1   2 , Marc Schluep  3   4 , Maksud Disli  5 , Prakriti Garkhail  5 , Dinis Dos Reis Miranda  6 , Robert-Jan Stolker  3 , Henrik Endeman  6 , Sanne Elisabeth Hoeks  3
Affiliations
Meta-Analysis

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Benjamin Yaël Gravesteijn et al. Crit Care. .

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 20, 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: ECPR 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.

Keywords: Brain injury; CPC; Cerebral performance category; ECPR; In-hospital cardiac arrest; Neurological outcome.

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Conflict of interest statement

The authors declare to have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart showing the process of inclusion of studies. The search strategy was performed on 20 December 2019
Fig. 2
Fig. 2
Forest plot showing the results for the primary outcome of this study, neurological outcome
Fig. 3
Fig. 3
Forest plot showing the results for the secondary outcome of this study, post-discharge survival
See this image and copyright information in PMC

References

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