Extracorporeal Versus Conventional Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrests

OBJECTIVES: It remains unclear whether extracorporeal cardiopulmonary resuscitation (ECPR) is more efficacious than conventional cardiopulmonary resuscitation (CPR) at improving survival with favorable neurological outcomes among patients with out-of-hospital cardiac arrests (OHCA). The authors sought to determine the efficacy of ECPR vs conventional CPR among patients with OHCA in the pre-hospital setting. METHODS: The authors searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing ECPR with conventional CPR for patients with OHCA. The primary outcome was survival with a favorable neurological outcome at 6-month follow-up. Count data were pooled across trials through random-effects models with inverse variance weighting to estimate risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: A total of 3 RCTs (n = 420) were included. Most patients (85%) were male, and the mean/median age ranged from 54 to 59 years. At 6 months, 28.4% of the patients randomized to ECPR survived with favorable neurological outcomes compared with 18.6% of the patients randomized to conventional CPR (RR, 1.47; 95% CI, 0.43-5.09). Similar results were obtained for survival at hospital discharge (RR, 1.35; 95% CI, 0.35-5.19). Risk of Bias 2 analysis indicated low risk in 1 trial and some concerns in others. CONCLUSIONS: ECPR may be associated with improved survival with favorable neurological outcomes at 6 months compared to conventional CPR for the treatment of OHCA. However, the available evidence remains inconclusive, and additional trials are needed to definitively assess the efficacy of ECPR compared to conventional CPR for OHCA.