Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Crit Care. 2020 Aug 17;24(1):505. doi: 10.1186/s13054-020-03201-0.
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.
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.
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%, I = 0%, p = 0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI 80-88%, I = 24%, p = 0.90).
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.
院内心搏骤停（IHCA）是一种严重的不良事件，如果治疗不当，死亡率很高。体外心肺复苏（ECPR）作为常规心肺复苏（CCPR）的辅助手段，是治疗 IHCA 的一种有前途的技术。关于 ECPR 后神经功能结局的证据仍然很少。
我们对截至 2019 年 12 月 20 日的所有研究进行了全面系统的检索。我们的主要结局是出院后任何时间 ECPR 的神经功能结局，用脑功能分类（CPC）评分来定义。评分 1 或 2 定义为良好结局。我们的次要结局是出院后的死亡率。采用固定效应荟萃分析。
我们的搜索结果为 1215 项，其中 19 项研究被纳入本系统综述。平均存活率为 30%（95%CI 28-33%，I=0%，p=0.24）。在存活患者中，良好神经功能结局的汇总百分比为 84%（95%CI 80-88%，I=24%，p=0.90）。
ECPR 作为治疗院内心搏骤停的方法，与大量神经功能良好的患者相关。良好结局的高比例可能是由于选择患者使用 ECPR 进行治疗。此外，存活率高于常规 CPR 文献中的描述。随着 ECPR 的适应证可能扩展到未来的老年或更脆弱的患者人群，研究应侧重于提高生存率，同时保持最佳的神经功能结局。
