Miraglia Dennis, Ayala Jonathan E
Department of Emergency Medicine San Francisco Hospital San Juan Puerto Rico USA.
Department of Emergency Medicine Good Samaritan Hospital Aguadilla Puerto Rico USA.
J Am Coll Emerg Physicians Open. 2021 Jan 18;2(1):e12361. doi: 10.1002/emp2.12361. eCollection 2021 Feb.
Veno-arterial extracorporeal membrane oxygenation has increasingly emerged as a feasible treatment to mitigate the progressive multiorgan dysfunction that occurs during cardiac arrest, in support of further resuscitation efforts.
Because the recent systematic review commissioned in 2018 by the International Liaison Committee on Resuscitation Advanced Life Support task did not include studies without a control group, our objective was to conduct a review incorporating these studies to increase available evidence supporting the use of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest patients, while waiting for high-quality evidence from randomized controlled trials (RCTs).
MEDLINE, Embase, and Science Citation Index (Web of Science) were searched for eligible studies from database inception to July 20, 2020. The population of interest was adult patients who had suffered cardiac arrest in any setting. We included all cohort studies with 1 exposure/1 group and descriptive studies (ie, case series studies). We excluded RCTs, non-RCTs, and observational analytic studies with a control group. Outcomes included short-term survival and favorable neurological outcome. Short-term outcomes (ie, hospital discharge, 30 days, and 1 month) were combined into a single category.
Our searches of databases and other sources yielded a total of 4302 citations. Sixty-two eligible studies were included (including a combined total of 3638 participants). Six studies were of in-hospital cardiac arrest, 34 studies were of out-of-hospital cardiac arrest, and 22 studies included both in-hospital and out-of-hospital cardiac arrest. Seven hundred and sixty-eight patients of 3352 (23%) had short-term survival; whereas, 602 of 3366 (18%) survived with favorable neurological outcome, defined as a cerebral performance category score of 1 or 2.
Current clinical evidence is mostly drawn from observational studies, with their potential for confounding selection bias. Although studies without controls cannot supplant case-control or cohort studies, several ECPR studies without a control group show successful resuscitation with impressive results that may provide valuable information to inform a comparison.
静脉 - 动脉体外膜肺氧合越来越多地成为一种可行的治疗方法，以减轻心脏骤停期间发生的进行性多器官功能障碍，支持进一步的复苏努力。
由于国际复苏联合会高级生命支持任务组在2018年委托进行的近期系统评价未纳入无对照组的研究，我们的目的是进行一项纳入这些研究的综述，以增加支持对心脏骤停患者使用体外心肺复苏（ECPR）的现有证据，同时等待来自随机对照试验（RCT）的高质量证据。
检索MEDLINE、Embase和科学引文索引（科学网），以查找从数据库建立到2020年7月20日的符合条件的研究。感兴趣的人群是在任何情况下发生心脏骤停的成年患者。我们纳入了所有单暴露/单组队列研究和描述性研究（即病例系列研究）。我们排除了RCT、非RCT以及有对照组的观察性分析研究。结局包括短期生存和良好的神经功能结局。短期结局（即出院、30天和1个月）合并为一个类别。
我们对数据库和其他来源的检索共获得4302条引文。纳入了62项符合条件的研究（包括总共3638名参与者）。6项研究为院内心脏骤停，34项研究为院外心脏骤停，22项研究包括院内心脏骤停和院外心脏骤停。3352名患者中有768名（23%）短期存活；而3366名患者中有602名（18%）存活且神经功能良好，定义为脑功能分类评分为1或2。
当前的临床证据大多来自观察性研究，存在混杂选择偏倚风险。虽然无对照组的研究不能替代病例对照或队列研究，但一些无对照组的ECPR研究显示复苏成功，结果令人印象深刻，可能为比较提供有价值的信息。
