Intensive Care Unit, Shunde Hospital, Southern Medical University (the First People's Hospital of Shunde), Foshan 528308, Guangdong Province, China.
Department of Pathology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, China.
Biomed Res Int. 2019 Jul 9;2019:6414673. doi: 10.1155/2019/6414673. eCollection 2019.
This meta-analysis with trial sequential analysis (TSA) compared the clinical efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) with conventional CPR (CCPR) for adult patients who experienced in-hospital cardiac arrest (IHCA) or out-of-hospital CA (OHCA).
A literature search was used to identify eligible publications (up to 30 July 2018) from PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase. Two investigators independently conducted the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and TSA were used to analyze each outcome, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence. The primary outcome was 30-day survival, and the secondary outcomes were 30-day neurologic outcome, 3-6 months' survival, 3-6 months' neurological outcome, 1-year survival, and 1-year neurological outcome.
We identified 13 eligible observational studies for the final analysis. Pooled analyses showed that ECPR was associated with a significantly better 30-day survival (RR = 1.60, 95% CI = 1.25-2.06) and 30-day neurologic outcome (RR = 2.69, 95% CI = 1.63-4.46), and TSA confirmed these results. However, subgroup analysis of patients with OHCA indicated that ECPR and CCPR had similar effects on 30-day survival (RR = 1.18, 95% CI = 0.71-1.97), which was not confirmed by TSA. Analysis of OHCA patients indicated that ECPR provided a better 30-day neurological outcome (RR = 3.93, 95% CI = 1.00-15.50), but TSA did not support these results. Analysis of IHCA patients indicated that ECPR was associated with a better 30-day survival (RR 1.90, 95% CI 1.43-2.52) and 30-day neurologic outcome (RR 2.02, 95% CI 1.21-3.39), and TSA supported these results. Other subgroup analyses showed that the results were generally consistent, regardless of nation, propensity score matching, presumed etiology, whether the CA was witnessed or not, and study quality.
Relative to CCPR, ECPR improved the survival and neurological outcome of patients who had IHCA. Compared to IHCA patients, TSA could not confirm better survival and neurologic outcome of ECPR in OHCA patients, suggesting that further studies are needed.
This trial was registered with PROSPERO (CRD42018100513) on 17 July 2018.
本荟萃分析采用试验序贯分析（TSA）比较体外心肺复苏（ECPR）与传统心肺复苏（CCPR）对院内心搏骤停（IHCA）或院外心搏骤停（OHCA）成人患者的临床疗效。
检索PubMed、Cochrane 图书馆、ISI Web of Knowledge 和 Embase 中截至 2018 年 7 月 30 日的相关文献，纳入符合条件的研究。两名研究者独立进行文献检索、研究选择、数据提取和质量评估。采用 Meta 分析和 TSA 分析各结局指标，并采用推荐评估、制定与评价（GRADE）系统评价证据质量。主要结局为 30 天生存率，次要结局为 30 天神经功能结局、3-6 个月生存率、3-6 个月神经功能结局、1 年生存率和 1 年神经功能结局。
最终纳入 13 项符合条件的观察性研究进行分析。汇总分析显示，ECPR 可显著提高 30 天生存率（RR=1.60，95%CI=1.25-2.06）和 30 天神经功能结局（RR=2.69，95%CI=1.63-4.46），且 TSA 也证实了这一结果。但对 OHCA 患者的亚组分析显示，ECPR 与 CCPR 对 30 天生存率的影响相似（RR=1.18，95%CI=0.71-1.97），但 TSA 并未证实这一结果。对 OHCA 患者的分析表明，ECPR 可获得更好的 30 天神经功能结局（RR=3.93，95%CI=1.00-15.50），但 TSA 不支持这一结果。对 IHCA 患者的分析表明，ECPR 可显著提高 30 天生存率（RR 1.90，95%CI=1.43-2.52）和 30 天神经功能结局（RR 2.02，95%CI=1.21-3.39），且 TSA 也支持这一结果。其他亚组分析结果基本一致，无论来自哪个国家、是否进行了倾向评分匹配、假设病因、CA 是否有目击者以及研究质量如何。
与 CCPR 相比，ECPR 可改善 IHCA 患者的生存率和神经功能结局。与 IHCA 患者相比，TSA 不能证实 OHCA 患者 ECPR 可获得更好的生存和神经功能结局，提示需要进一步研究。
本研究于 2018 年 7 月 17 日在 PROSPERO（CRD42018100513）进行注册。
