• Fabio Silvio Taccone, Andrea Minini, Leonello Avalli, Kristin Alm-Kruse, Filippo Annoni, Wulfran Bougouin, Aidan Burrell, Alain Cariou, Giacomo Coppalini, Brian Grunau, Toru Hifumi, Hsu Heng Yen, Xavier Jouven, Jae Seung Jung, Roberto Lorusso, Kunihiko Maekawa, Sivagowry Rasalingam Mørk, Daniel Rob, Andreas Schober, Atman P Shah, Sandra Emily Stoll, Martje M Suverein, Takahiro Nakashima, Marcel C G Vande Poll, Demetrios Yannopoulos, Won Young Kim, and Jan Belohlavek.
• Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium. Electronic address: ftaccone@ulb.ac.be.
• Resuscitation. 2024 Aug 12; 202: 110357110357.

BackgroundWe aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).MethodsA systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio. The primary and secondary outcomes were unfavorable neurological outcome (Cerebral Performance Category of 3-5) and mortality, respectively, which were both collected at different time-points.ResultsData from 17 studies, including 2064 matched cardiac arrest (CA) patients (1031 ECPR and 1033 CCPR cases) were included. In comparison to CCPR, ECPR was associated with a decreased odds of unfavorable neurological outcome (847, 82.2% vs. 897, 86.8% - OR 0.68 [95%CI 0.53-0.87]; p = 0.002) and death (803, 77.9% vs. 860, 83.3% - OR 0.68 [95%CI 0.54-0.86]; p = 0.001). These results were consistent across most of the prespecified subgroups. Moreover, the odds of both unfavorable neurological outcome and mortality were significantly influenced by initial rhythm, cause of arrest and combinations of lactate levels on admission and duration of resuscitation.ConclusionsThis IPDMA showed that ECPR was associated with significantly lower rates of unfavorable neurological outcome and mortality in refractory CA. The overall effect could be influenced by CA characteristics and the severity of the initial injury.Copyright © 2024 Elsevier B.V. All rights reserved.

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