Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Cardiac arrest Critical care Emergency medicine Extracorporeal cardiopulmonary resuscitation Extracorporeal life support

Journal

Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173

Informations de publication

Date de publication:
Dec 2023
Historique:
received: 22 07 2023
revised: 10 10 2023
accepted: 11 10 2023
pubmed: 21 10 2023
medline: 21 10 2023
entrez: 20 10 2023
Statut: ppublish

Résumé

Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established. We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach. We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes). The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.

Sections du résumé

BACKGROUND BACKGROUND
Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established.
METHODS METHODS
We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach.
FINDINGS RESULTS
We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes).
INTERPRETATION CONCLUSIONS
The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.

Identifiants

DOI: 10.1016/j.resuscitation.2023.110004 PMID: 37863420
pubmed: 37863420
pii: S0300-9572(23)00319-2
doi: 10.1016/j.resuscitation.2023.110004
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

110004

Informations de copyright

Copyright © 2023 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Alexandre Tran has no conflicts to report. Dr. Bram Rochwerg has no conflicts to report. Dr. Eddy Fan reports receiving personal fees from ALung Technologies, Baxter, Inspira, Vasomune, and Zoll Medical outside of the submitted work. He serves on the Executive Committee and is Chair of the Data Committee for the International ECMO Network (ECMONet). Dr. Jan Belohlavek reports receiving lecture and consultancy honoraria outside of the submitted work from Getinge, Abiomed, Xenios, Resuscitec, Novartis, Bayer, Boehringer-Ingelheim and AstraZeneca Companies. Dr. Martje M. Suverein has no conflicts to report. Dr. Marcel C. G. van de Poll has no conflicts to report. Dr. Roberto Lorusso reports consulting activities for Medtronic, Livanova, Getinge and receiving lecture fees from Abiomed. He serves on the Medical Advisory Board of Xenios and Eurosets. Dr. Susanna Price has no conflicts to report. Dr. Demetris Yannopoulos has no conflicts to report. Dr. Graeme MacLaren serves on the Executive Committee of the Extracorporeal Life Support Organization (ELSO). Dr. Kollengode Ramanathan is the co-Chair of the Scientific Oversight Committee at ELSO and has received honoraria for educational talks outside the submitted work from Fresenius and Baxter. Ryan Ruiyang Ling receives research support from the Clinician Scientist Development Unit, National University of Singapore. Dr. Sonny Thiara has no conflicts to report. Dr. Joseph E. Tonna is the Chair of the Registry of the Extracorporeal Life Support Organization (ELSO). Dr. Kiran Shekar serves on the Scientific Committee and Network Committee of ECMONet.He reports receiving lecture honoraria outside of the submitted work from Getinge and Abiomed. Dr. Carol L. Hodgson serves on the Executive Committee, Scientific Committee, and Data Committee of ECMONet. Dr. Damon C. Scales has no conflicts to report. Dr. Claudio Sandroni has no conflicts to report. Dr. Jerry P. Nolan receives support from Elsevier for his role as Editor-in-Chief for Resuscitation. Dr. Arthur S. Slutsky reports consulting for Baxter International Inc. and Xenios. He serves on the Executive Committee and is Chair of the Scientific Committee of ECMONet. Dr. Alain Combes reports receiving personal fees from Getinge, Xenios, and Baxter International Inc. He serves on the Executive Committee and Scientific Committee of ECMONet, and is Past-President of the European Extracorporeal Life Support Organization (EuroELSO). Dr. Daniel Brodie receives research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet), and he writes for UpToDate. Dr. Shannon M. Fernando has no conflicts to report.

Auteurs

Alexandre Tran (A)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada. Electronic address: aletran@toh.ca.

Bram Rochwerg (B)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

Eddy Fan (E)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Jan Belohlavek (J)

2(nd) Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; First Faculty of Medicine, Charles University in Prague, Czech Republic.

Martje M Suverein (MM)

Department of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands.

Marcel C G van de Poll (MCGV)

Department of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands.

Roberto Lorusso (R)

Department of Cardiothoracic Surgery, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.

Susanna Price (S)

Royal Brompton & Harefield Hospitals, London, UK; National Heart and Lung Institute, Imperial College, London, UK.

Demetris Yannopoulos (D)

Division of Cardiology and Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.

Graeme MacLaren (G)

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore.

Kollengode Ramanathan (K)

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore.

Ryan Ruiyang Ling (RR)

Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Sonny Thiara (S)

Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.

Joseph E Tonna (JE)

Departments of Emergency Medicine and Cardiothoracic Surgery, University of Utah Health, Salt Lake City, UT, USA.

Kiran Shekar (K)

Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane and Bond University, Gold Coast, Queensland, Australia.

Carol L Hodgson (CL)

Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, Australia.

Damon C Scales (DC)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Claudio Sandroni (C)

Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.

Jerry P Nolan (JP)

Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.

Arthur S Slutsky (AS)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

Alain Combes (A)

Sorbonne Université, Institute of Cardiometabolism and Nutrition, Paris, France; Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France.

Daniel Brodie (D)

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Shannon M Fernando (SM)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.

Classifications MeSH