Cardiac arrest & resuscitation
Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis
Pooled result · High certaintyResult — go to the resultOdds ratio 0.67 95% CI 0.51–0.87Authors' conclusion
Compared with CCPR, ECPR reduced in-hospital mortality and improved long-term neurological outcomes and post-arrest survival, particularly in patients with IHCA.
Study context
- Population
- Adults (aged ≥18 years) with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA)11 studies
- Participants
- 4,595 vs 4,597
- Comparison
- Extracorporeal cardiopulmonary resuscitation (ECPR) vs conventional CPR
- ECPRn = 4,595
- Conventional cardiopulmonary resuscitation (CCPR)n = 4,597reference
- Outcome
- In-hospital mortality
Methodological detailsrandom-effects (Mantel-Haenszel), trial sequential analysis, Grading of Recommendations, Assessments, Developments, and Evaluations (GRADE)
- Random-effects (Mantel-Haenszel)
- Trial sequential analysis
- GRADE
Pooled result
High certainty
Odds ratio
0.67
95% CI 0.51–0.87
P = 0.0034
ECPR vs CCPR
OR 0.67 (95% CI 0.51–0.87); P = 0.0034
As reported in the abstract
Further pooled results
| Outcome | Estimate | P value | |
|---|---|---|---|
| In-hospital mortality, IHCA only (subgroup) | OR for in-hospital death 0.42 (95% CI 0.25–0.70) | P = 0.0009 | |
| In-hospital mortality, OHCA only (subgroup)No differences found | OR for in-hospital death 0.76 (95% CI 0.54–1.07) | P = 0.12 | |
| Short-term survival with favourable neurological outcome (CPC 1 or 2; hospital discharge to 30 days)Moderate certainty | OR for survival with favourable neurological outcome 1.65 (95% CI 1.02–2.68) | P = 0.042 | |
| Long-term survival with favourable neurological outcome (CPC 1 or 2; ≥90 days)High certainty | OR for survival with favourable neurological outcome 2.04 (95% CI 1.41–2.94) | P = 0.0001 | |
| Survival · 30 days | OR for survival 1.45 (95% CI 1.08–1.96) | P = 0.015 | |
| Survival · 3 months | OR for survival 3.98 (95% CI 1.12–14.16) | P = 0.033 | |
| Survival · 6 months | OR for survival 1.87 (95% CI 1.36–2.57) | P = 0.0001 | |
| Survival · 1 year | OR for survival 1.72 (95% CI 1.52–1.95) | P < 0.0001 | |
| 0.050.21520Ratio (log scale) |
| Outcome | Regression coefficient per doubling of centre volume (odds of mortality) (95% CI) | P value |
|---|---|---|
| Centre volume (ECPR runs per year per centre) and odds of mortality | −0.17 (−0.32 to −0.017) | P = 0.030 |
Original publication
Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis. Lancet Respir Med. Published 22 May 2023. doi:10.
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