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Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis
A. Tran, B. Rochwerg, E. Fan, J. Belohlavek, MM. Suverein, MCGV. Poll, R. Lorusso, S. Price, D. Yannopoulos, G. MacLaren, K. Ramanathan, RR. Ling, S. Thiara, JE. Tonna, K. Shekar, CL. Hodgson, DC. Scales, C. Sandroni, JP. Nolan, AS. Slutsky, A....
Language English Country Ireland
Document type Meta-Analysis, Systematic Review, Journal Article, Review
- MeSH
- Adult MeSH
- Cardiopulmonary Resuscitation * MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * MeSH
- Odds Ratio MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Out-of-Hospital Cardiac Arrest * therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established. METHODS: We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach. FINDINGS: We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes). INTERPRETATION: The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.
1st Faculty of Medicine Charles University Prague Czech Republic
Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Australia
Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa ON Canada
Department of Anaesthesia and Intensive Care Medicine Royal United Hospital Bath UK
Department of Critical Care Lakeridge Health Corporation Oshawa ON Canada
Department of Health Research Methods Evidence and Impact McMaster University Hamilton ON Canada
Department of Intensive Care Maastricht University Medical Centre Maastricht the Netherlands
Department of Medicine Division of Critical Care McMaster University Hamilton ON Canada
Department of Surgery University of Ottawa Ottawa ON Canada
Division of Critical Care Department of Medicine University of Ottawa Ottawa ON Canada
Interdepartmental Division of Critical Care Medicine University of Toronto Toronto ON Canada
National Heart and Lung Institute Imperial College London UK
Royal Brompton and Harefield Hospitals London UK
Sorbonne Université Institute of Cardiometabolism and Nutrition Paris France
Toronto General Hospital Research Institute University Health Network Toronto ON Canada
Warwick Clinical Trials Unit Warwick Medical School Warwick University Gibbet Hill Coventry UK
Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
References provided by Crossref.org
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- $a Tran, Alexandre $u Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada. Electronic address: aletran@toh.ca
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