Cheema Huzaifa Ahmad, Shafiee Arman, Jafarabady Kyana, Seighali Niloofar, Shahid Abia, Ahmad Adeel, Ahmad Imama, Ahmad Soban, Pahuja Mohit, Dani Sourbha S
Department of Cardiology, King Edward Medical University, Lahore, Pakistan.
Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran.
Pacing Clin Electrophysiol. 2023 Oct;46(10):1246-1250. doi: 10.1111/pace.14820. Epub 2023 Sep 12.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a resuscitation method for patients with refractory out-of-hospital cardiac arrest (OHCA). However, evidence from randomized controlled trials (RCTs) is lacking.
We searched several electronic databases until March 2023 for RCTs comparing ECPR with conventional CPR in OHCA patients. RevMan 5.4 was used to pool risk ratios (RR) with 95% confidence intervals (CIs).
A total of four RCTs were included. The results of our meta-analysis showed no statistically significant benefit of ECPR regarding mid-term survival (RR 1.21; 95% CI 0.64 to 2.28; I = 48%; p = .55). We found a significant improvement with ECPR in mid-term favorable neurological outcome (RR 1.59; 95% CI 1.09 to 2.33; I = 0%; p = .02). There was no significant difference between ECPR and conventional CPR in long-term survival (RR 1.32; 95% CI 0.18 to 9.50; I = 64%; p = .79), and long-term favorable neurological outcome (RR 1.47; 95% CI 0.89 to 2.43; I = 25%; p = .13). There was an increased incidence of adverse events in the ECPR group (RR 3.22; 95% CI 1.18 to 8.80; I = 63%; p = .02).
ECPR in OHCA patients was not associated with improved survival or long-term favorable neurological outcome but did improve favorable neurological outcome in the mid-term. However, these results are likely underpowered due to the small number of available RCTs. Large-scale confirmatory RCTs are needed to provide definitive conclusions.
体外心肺复苏（ECPR）是用于院外心脏骤停（OHCA）难治性患者的一种复苏方法。然而，缺乏来自随机对照试验（RCT）的证据。
我们检索了多个电子数据库直至2023年3月，以查找比较OHCA患者中ECPR与传统心肺复苏的随机对照试验。使用RevMan 5.4汇总风险比（RR）及95%置信区间（CI）。
共纳入四项随机对照试验。我们的荟萃分析结果显示，就中期生存率而言，ECPR无统计学显著益处（RR 1.21；95% CI 0.64至2.28；I² = 48%；p = 0.55）。我们发现ECPR在中期良好神经功能转归方面有显著改善（RR 1.59；95% CI 1.09至2.33；I² = 0%；p = 0.02）。在长期生存率方面，ECPR与传统心肺复苏之间无显著差异（RR 1.32；95% CI 0.18至9.50；I² = 64%；p = 0.79），在长期良好神经功能转归方面亦无显著差异（RR 1.47；95% CI 0.89至2.43；I² = 25%；p = 0.13）。ECPR组不良事件发生率增加（RR 3.22；95% CI 1.18至8.80；I² = 63%；p = 0.02）。
OHCA患者的ECPR与生存率改善或长期良好神经功能转归无关，但在中期确实改善了良好神经功能转归。然而，由于可用随机对照试验数量较少，这些结果可能效力不足。需要大规模的验证性随机对照试验来提供确切结论。
