Leroux Lawrence, Dennis-Benford Nathaniel B, Bergeron Amy, Lamhaut Lionel, Cournoyer Alexis, Grunau Brian, Cavayas Yiorgos Alexandros
Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Canada.
Resusc Plus. 2025 May 8;24:100974. doi: 10.1016/j.resplu.2025.100974. eCollection 2025 Jul.
Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) has been proposed to reduce delays in ECPR delivery in refractory out-of-hospital cardiac arrests (OHCA) and improve outcomes. Our aim was to synthesize the literature on outcomes of prehospital ECPR in OHCA, focusing on low-flow times (emergency call to extracorporeal blood flow) and survival with good neurological function, comparing them to in-hospital ECPR when possible.
We conducted a systematic review and -analysis of studies reporting outcomes in adult OHCA patients treated with prehospital ECPR. Searches spanned seven databases and relevant grey literature (last updated January 21, 2025). Eligible studies included ≥ 5 patients. The primary outcome was survival with good neurological function (CPC 1-2). Pooled estimates were calculated using random-effects models. Meta-regression assessed the association between low-flow time and survival. Comparative analyses with in-hospital ECPR were performed when possible.
Eight cohort studies involving 305 patients (84% male, mean age 57) were included. Survival with good neurological function was 25% (95%CI: 17-35%). Mean low-flow time was 59 min (95%CI: 46-72). Meta-regression showed a significant inverse association between low-flow time and good neurological outcomes (β = -0.0271, 95%CI: -0.0536 to -0.0006; p = 0.045). Compared to in-hospital ECPR, prehospital ECPR showed no significant difference in survival (RR 1.23, 95%CI: 0.35-4.38) but was associated with significantly shorter low-flow times (mean difference -30 min, 95%CI: -44 to -16).
Prehospital ECPR is associated with a 25% rate of survival with good neurological function. Shorter low-flow times were associated with improved outcomes.
院前体外心肺复苏（ECPR）已被提出用于减少难治性院外心脏骤停（OHCA）患者接受ECPR的延迟并改善预后。我们的目的是综合关于OHCA患者院前ECPR预后的文献，重点关注低流量时间（急救电话至体外血流时间）和具有良好神经功能的存活情况，并在可能的情况下将其与院内ECPR进行比较。
我们对报告院前ECPR治疗成年OHCA患者预后的研究进行了系统评价和分析。检索涵盖七个数据库和相关灰色文献（最后更新于2025年1月21日）。符合条件的研究纳入≥5例患者。主要结局是具有良好神经功能的存活（脑功能分类1-2级）。使用随机效应模型计算合并估计值。Meta回归评估低流量时间与存活之间的关联。在可能的情况下，与院内ECPR进行比较分析。
纳入八项队列研究，共305例患者（84%为男性，平均年龄57岁）。具有良好神经功能的存活率为25%（95%置信区间：17-35%）。平均低流量时间为59分钟（95%置信区间：46-72）。Meta回归显示低流量时间与良好神经功能结局之间存在显著负相关（β=-0.0271，95%置信区间：-0.0536至-0.0006；p=0.045）。与院内ECPR相比，院前ECPR在存活方面无显著差异（风险比1.23，95%置信区间：0.35-4.38），但低流量时间显著更短（平均差值-30分钟，95%置信区间：-44至-16）。
院前ECPR与25%的具有良好神经功能的存活率相关。较短的低流量时间与改善的预后相关。
