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New Meta-analysis – ECPR vs CPR in Cardiac Arrest

March 14, 2024

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Written by Clark Strunk

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This updated meta-analysis re-demonstrated a benefit for extracorporeal cardiopulmonary resuscitation (ECPR) in reducing overall in-hospital cardiac arrest (IHCA) mortality and improving neurological outcomes after cardiac arrest but also demonstrated a new significant reduction in out of hospital cardiac arrest (OHCA) mortality with ECPR.

It’s a go, for ECMO!
We just covered a review of ECPR for refractory OHCA on JournalFeed that found little benefit but had significant caveats. This article is an updated meta-analysis that includes two new studies comparing ECPR and conventional CPR. A prior meta-analysis published by the same group in 2023 found a reduction in IHCA with ECPR; however, this was not found with OHCA. This meta-analysis included 13 studies and 14,048 patients and performed trial sequential analyses to ensure the required information sizes were obtained to detect a clinically relevant reduction in mortality. Overall, this updated meta-analysis demonstrated a reduction in in-hospital mortality, OR 0.63 (95%CI 0.50-0.79), and a reduction in mortality in OHCA, OR 0.62 (0.45-0.84). A major strength of this study is the inclusion of both IHCA and OHCA, as well as shockable and non-shockable rhythms, with the inclusion of multiple different practice settings and resource levels. A notable limitation is the variable inclusion criteria used to select patients in each study.

How will this change my practice?
The results of this meta-analysis will continue to lower my threshold to consider ECPR for refractory cardiac arrest. Although there have been some conflicting data regarding benefit in various patient populations and settings, this meta-analysis provides compelling evidence of a benefit to ECPR in both IHCA and OHCA. Consequently, I foresee me involving the ECMO team more and more for my patients in cardiac arrest.

Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis. Crit Care. 2024 Feb 21;28(1):57. doi: 10.1186/s13054-024-04830-5.

What are your thoughts?