• Resuscitation · Mar 2017

    Review Meta Analysis

    Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis.

    • Guillaume Debaty, Valentin Babaz, Michel Durand, Lucie Gaide-Chevronnay, Emmanuel Fournel, Marc Blancher, Hélène Bouvaist, Olivier Chavanon, Maxime Maignan, Pierre Bouzat, Pierre Albaladejo, and José Labarère.
    • University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France. Electronic address: gdebaty@gmail.com.
    • Resuscitation. 2017 Mar 1; 112: 1-10.

    PurposeAssociation estimates between baseline characteristics and outcomes are imprecise and inconsistent among extracorporeal cardiopulmonary resuscitation (ECPR) recipients following refractory out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis aimed to investigate the prognostic significance of pre-specified characteristics for OHCA treated with ECPR.MethodsThe Medline electronic database was searched via PubMed for articles published from January 2000 to September 2016. The electronic search was supplemented by scanning the reference lists of retrieved articles and contacting field experts. Eligible studies were historical and prospective cohort studies of adult patients undergoing ECPR following OHCA.ResultsFifteen primary studies were included, totaling 841 participants. The median prevalence of the primary outcome (i.e., short- or long-term survival for five studies and cerebral performance for ten studies) was 15% (range, 0-50%). The primary outcome was associated with an increased odds ratio of initial shockable cardiac rhythm (2.20; 95% confidence interval [CI], 1.30-3.72; P=0.003), shorter low-flow duration (geometric mean ratio, 0.90; 95% CI, 0.81-0.99; P=0.04), higher arterial pH value (difference, 0.12; 95% CI, 0.03-0.22; P=0.01) and lower serum lactate concentration (difference, -3.52mmol/L; 95% CI, -5.05 to -1.99; P<0.001). No significant association was found between the primary outcome and patient age (the odds of female gender and bystander CPR attempt.ConclusionObservational evidence from published primary studies indicates that shorter low-flow duration, shockable cardiac rhythm, higher arterial pH value and lower serum lactate concentration on hospital admission are associated with better outcomes for ECPR recipients after OHCA.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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