Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) may reduce mortality and improve neurological outcomes in patients with cardiac arrest. We updated our existing meta-analysis and trial sequential analysis to further evaluate ECPR compared to conventional CPR (CCPR).

Methods

We searched three international databases from 1 January 2000 through 1 November 2023, for randomised controlled trials or propensity score matched studies (PSMs) comparing ECPR to CCPR in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). We conducted an updated random-effects meta-analysis, with the primary outcome being in-hospital mortality. Secondary outcomes included short- and long-term favourable neurological outcome and survival (30 days–1 year). We also conducted a trial sequential analysis to evaluate the required information size in the meta-analysis to detect a clinically relevant reduction in mortality.

Results

We included 13 studies with 14 pairwise comparisons (6336 ECPR and 7712 CCPR) in our updated meta-analysis. ECPR was associated with greater precision in reducing overall in-hospital mortality (OR 0.63, 95% CI 0.50–0.79, high certainty), to which the trial sequential analysis was concordant. The addition of recent studies revealed a newly significant decrease in mortality in OHCA (OR 0.62, 95% CI 0.45–0.84). Re-analysis of relevant secondary outcomes reaffirmed our initial findings of favourable short-term neurological outcomes and survival up to 30 days. Estimates for long-term neurological outcome and 90-day–1-year survival remained unchanged.

Conclusions

We found that ECPR reduces in-hospital mortality, improves neurological outcome, and 30-day survival. We additionally found a newly significant benefit in OHCA, suggesting that ECPR may be considered in both IHCA and OHCA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-024-04830-5.

Related collections

Most cited references 24

Record: found
Abstract: found
Article: found

Is Open Access

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2024)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

0 comments Cited 12724 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Meta-analysis in clinical trials

Rebecca DerSimonian, Nan Laird (1986)

0 comments Cited 3461 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

Gordon Guyatt, Andrew D Oxman, Elie A. Akl … (2011)

This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.

0 comments Cited 1977 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Yohei Okada: yohei_ok@duke-nus.edu.sg , yokada-kyf@umin.ac.jp

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 21 February 2024

Publication date PMC-release: 21 February 2024

Publication date Collection: 2024

Volume: 28

Electronic Location Identifier: 57

Affiliations

[1 ]GRID grid.4280.e, ISNI 0000 0001 2180 6431, Yong Loo Lin School of Medicine, , National University of Singapore, National Unviersity Health System, ; Singapore, Singapore

[2 ]GRID grid.488497.e, ISNI 0000 0004 1799 3088, Cardiothoracic Intensive Care Unit, , National University Heart Centre Singapore, National University Health System, ; Singapore, Singapore

[3 ] Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), ( https://ror.org/05k8wg936) Singapore, Singapore

[4 ]Division of Critical Care, Department of Medicine, McMaster University, ( https://ror.org/02fa3aq29) Hamilton, ON Canada

[5 ]Department of Health Research Methods, Evidence, and Impact, McMaster University, ( https://ror.org/02fa3aq29) Hamilton, ON Canada

[6 ]Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, ( https://ror.org/035t8zc32) Osaka, Japan

[7 ]Preventive Services, Graduate School of Medicine, School of Public Health, Kyoto University, ( https://ror.org/02kpeqv85) Kyoto, Japan

[8 ]Health Services and Systems Research, Duke-NUS Medical School, ( https://ror.org/02j1m6098) Singapore, Singapore

[9 ]Department of Emergency Medicine, Singapore General Hospital, ( https://ror.org/036j6sg82) Singapore, Singapore

Article

Publisher ID: 4830

DOI: 10.1186/s13054-024-04830-5

PMC ID: 10882798

PubMed ID: 38383506

SO-VID: 13fcd8fa-b379-408e-b1d0-a6f2b7ff1168

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 11 December 2023

Date accepted : 10 February 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100016867, ZOLL Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/501100001691, Japan Society for the Promotion of Science;

Award ID: JP23K16253

Award Recipient : Yohei Okada

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: extracorporeal membrane oxygenation,cardiac arrest,cardiopulmonary resuscitation,meta-analysis

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: extracorporeal membrane oxygenation, cardiac arrest, cardiopulmonary resuscitation, meta-analysis

Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis

Read this article at

Abstract

Background

Methods

Results

Conclusions

Supplementary Information

Related collections

Irish Journal of Paramedicine

Most cited references 24

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Meta-analysis in clinical trials

GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 209

Cited by 3

Most referenced authors 907