• Alexandre Tran, Bram Rochwerg, Eddy Fan, Jan Belohlavek, Martje M Suverein, PollMarcel C G van deMCGVDepartment of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands., Roberto Lorusso, Susanna Price, Demetris Yannopoulos, Graeme MacLaren, Kollengode Ramanathan, Ryan Ruiyang Ling, Sonny Thiara, Joseph E Tonna, Kiran Shekar, Carol L Hodgson, Damon C Scales, Claudio Sandroni, Jerry P Nolan, Arthur S Slutsky, Alain Combes, Daniel Brodie, and Shannon M Fernando.
• Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada. Electronic address: aletran@toh.ca.
• Resuscitation. 2023 Dec 1; 193: 110004110004.

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established.MethodsWe conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach.FindingsWe included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes).InterpretationThe findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.Copyright © 2023 Elsevier B.V. All rights reserved.

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