Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis

Fabio Silvio Taccone; Andrea Minini; Leonello Avalli; Kristin Alm-Kruse; Filippo Annoni; Wulfran Bougouin; Aidan Burrell; Alain Cariou; Giacomo Coppalini; Brian Grunau; Toru Hifumi; Hsu Heng Yen; Xavier Jouven; Jae Seung Jung; Roberto Lorusso; Kunihiko Maekawa; Sivagowry Rasalingam Mørk; Daniel Rob; Andreas Schober; Atman P Shah; Sandra Emily Stoll; Martje M Suverein; Takahiro Nakashima; Marcel Cg Vande Poll; Demetrios Yannopoulos; Won Young Kim; Jan Belohlavek

doi:10.1016/j.resuscitation.2024.110357

Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis

Fabio Silvio Taccone, Andrea Minini, Leonello Avalli, Kristin Alm-Kruse, Filippo Annoni, Wulfran Bougouin, Aidan Burrell, Alain Cariou, Giacomo Coppalini, Brian Grunau, Toru Hifumi, Hsu Heng Yen, Xavier Jouven, Jae Seung Jung, Roberto Lorusso, Kunihiko Maekawa, Sivagowry Rasalingam Mørk, Daniel Rob, Andreas Schober, Atman P ShahSandra Emily Stoll, Martje M Suverein, Takahiro Nakashima, Marcel Cg Vande Poll, Demetrios Yannopoulos, Won Young Kim, Jan Belohlavek

Department of Clinical Medicine - The Department of Cardiological Medicine B

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

BACKGROUND: We aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).

METHODS: A systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio. The primary and secondary outcomes were unfavorable neurological outcome (Cerebral Performance Category of 3-5) and mortality, respectively, which were both collected at different time-points.

RESULTS: Data from 17 studies, including 2064 matched cardiac arrest (CA) patients (1031 ECPR and 1033 CCPR cases) were included. In comparison to CCPR, ECPR was associated with a decreased odds of unfavorable neurological outcome (847, 82.2% vs. 897, 86.8% - OR 0.68 [95%CI 0.53-0.87]; p=0.002) and death (803, 77.9% vs. 860, 83.3% - OR 0.68 [95%CI 0.54-0.86]; p=0.001). These results were consistent across most of the prespecified subgroups. Moreover, the odds of both unfavorable neurological outcome and mortality were significantly influenced by initial rhythm, cause of arrest and combinations of lactate levels on admission and duration of resuscitation.

CONCLUSIONS: This IPDMA showed that ECPR was associated with significantly lower rates of unfavorable neurological outcome and mortality in refractory CA. The overall effect could be influenced by CA characteristics and the severity of the initial injury.

Original language	English
Article number	110357
Journal	Resuscitation
Volume	202
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2024.110357
Publication status	Published - Sept 2024

Keywords

Cardiac arrest
ECPR
Meta-analysis
Outcome

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Silvio Taccone, F., Minini, A., Avalli, L., Alm-Kruse, K., Annoni, F., Bougouin, W., Burrell, A., Cariou, A., Coppalini, G., Grunau, B., Hifumi, T., Heng Yen, H., Jouven, X., Seung Jung, J., Lorusso, R., Maekawa, K., Rasalingam Mørk, S., Rob, D., Schober, A., ... Belohlavek, J. (2024). Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis. Resuscitation, 202, Article 110357. https://doi.org/10.1016/j.resuscitation.2024.110357

@article{7e55fba5c0154e6e864a888296dba637,

title = "Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis",

abstract = "BACKGROUND: We aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).METHODS: A systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio. The primary and secondary outcomes were unfavorable neurological outcome (Cerebral Performance Category of 3-5) and mortality, respectively, which were both collected at different time-points.RESULTS: Data from 17 studies, including 2064 matched cardiac arrest (CA) patients (1031 ECPR and 1033 CCPR cases) were included. In comparison to CCPR, ECPR was associated with a decreased odds of unfavorable neurological outcome (847, 82.2% vs. 897, 86.8% - OR 0.68 [95%CI 0.53-0.87]; p=0.002) and death (803, 77.9% vs. 860, 83.3% - OR 0.68 [95%CI 0.54-0.86]; p=0.001). These results were consistent across most of the prespecified subgroups. Moreover, the odds of both unfavorable neurological outcome and mortality were significantly influenced by initial rhythm, cause of arrest and combinations of lactate levels on admission and duration of resuscitation.CONCLUSIONS: This IPDMA showed that ECPR was associated with significantly lower rates of unfavorable neurological outcome and mortality in refractory CA. The overall effect could be influenced by CA characteristics and the severity of the initial injury.",

keywords = "Cardiac arrest, ECPR, Meta-analysis, Outcome",

author = "{Silvio Taccone}, Fabio and Andrea Minini and Leonello Avalli and Kristin Alm-Kruse and Filippo Annoni and Wulfran Bougouin and Aidan Burrell and Alain Cariou and Giacomo Coppalini and Brian Grunau and Toru Hifumi and {Heng Yen}, Hsu and Xavier Jouven and {Seung Jung}, Jae and Roberto Lorusso and Kunihiko Maekawa and {Rasalingam M{\o}rk}, Sivagowry and Daniel Rob and Andreas Schober and Shah, {Atman P} and {Emily Stoll}, Sandra and Suverein, {Martje M} and Takahiro Nakashima and {Cg Vande Poll}, Marcel and Demetrios Yannopoulos and {Young Kim}, Won and Jan Belohlavek",

year = "2024",

month = sep,

doi = "10.1016/j.resuscitation.2024.110357",

language = "English",

volume = "202",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd.",

}

Silvio Taccone, F, Minini, A, Avalli, L, Alm-Kruse, K, Annoni, F, Bougouin, W, Burrell, A, Cariou, A, Coppalini, G, Grunau, B, Hifumi, T, Heng Yen, H, Jouven, X, Seung Jung, J, Lorusso, R, Maekawa, K, Rasalingam Mørk, S, Rob, D, Schober, A, Shah, AP, Emily Stoll, S, Suverein, MM, Nakashima, T, Cg Vande Poll, M, Yannopoulos, D, Young Kim, W & Belohlavek, J 2024, 'Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis', Resuscitation, vol. 202, 110357. https://doi.org/10.1016/j.resuscitation.2024.110357

Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis. / Silvio Taccone, Fabio; Minini, Andrea; Avalli, Leonello et al.
In: Resuscitation, Vol. 202, 110357, 09.2024.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest

T2 - an individual pooled patient data meta-analysis

AU - Silvio Taccone, Fabio

AU - Minini, Andrea

AU - Avalli, Leonello

AU - Alm-Kruse, Kristin

AU - Annoni, Filippo

AU - Bougouin, Wulfran

AU - Burrell, Aidan

AU - Cariou, Alain

AU - Coppalini, Giacomo

AU - Grunau, Brian

AU - Hifumi, Toru

AU - Heng Yen, Hsu

AU - Jouven, Xavier

AU - Seung Jung, Jae

AU - Lorusso, Roberto

AU - Maekawa, Kunihiko

AU - Rasalingam Mørk, Sivagowry

AU - Rob, Daniel

AU - Schober, Andreas

AU - Shah, Atman P

AU - Emily Stoll, Sandra

AU - Suverein, Martje M

AU - Nakashima, Takahiro

AU - Cg Vande Poll, Marcel

AU - Yannopoulos, Demetrios

AU - Young Kim, Won

AU - Belohlavek, Jan

PY - 2024/9

Y1 - 2024/9

N2 - BACKGROUND: We aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).METHODS: A systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio. The primary and secondary outcomes were unfavorable neurological outcome (Cerebral Performance Category of 3-5) and mortality, respectively, which were both collected at different time-points.RESULTS: Data from 17 studies, including 2064 matched cardiac arrest (CA) patients (1031 ECPR and 1033 CCPR cases) were included. In comparison to CCPR, ECPR was associated with a decreased odds of unfavorable neurological outcome (847, 82.2% vs. 897, 86.8% - OR 0.68 [95%CI 0.53-0.87]; p=0.002) and death (803, 77.9% vs. 860, 83.3% - OR 0.68 [95%CI 0.54-0.86]; p=0.001). These results were consistent across most of the prespecified subgroups. Moreover, the odds of both unfavorable neurological outcome and mortality were significantly influenced by initial rhythm, cause of arrest and combinations of lactate levels on admission and duration of resuscitation.CONCLUSIONS: This IPDMA showed that ECPR was associated with significantly lower rates of unfavorable neurological outcome and mortality in refractory CA. The overall effect could be influenced by CA characteristics and the severity of the initial injury.

AB - BACKGROUND: We aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).METHODS: A systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio. The primary and secondary outcomes were unfavorable neurological outcome (Cerebral Performance Category of 3-5) and mortality, respectively, which were both collected at different time-points.RESULTS: Data from 17 studies, including 2064 matched cardiac arrest (CA) patients (1031 ECPR and 1033 CCPR cases) were included. In comparison to CCPR, ECPR was associated with a decreased odds of unfavorable neurological outcome (847, 82.2% vs. 897, 86.8% - OR 0.68 [95%CI 0.53-0.87]; p=0.002) and death (803, 77.9% vs. 860, 83.3% - OR 0.68 [95%CI 0.54-0.86]; p=0.001). These results were consistent across most of the prespecified subgroups. Moreover, the odds of both unfavorable neurological outcome and mortality were significantly influenced by initial rhythm, cause of arrest and combinations of lactate levels on admission and duration of resuscitation.CONCLUSIONS: This IPDMA showed that ECPR was associated with significantly lower rates of unfavorable neurological outcome and mortality in refractory CA. The overall effect could be influenced by CA characteristics and the severity of the initial injury.

KW - Cardiac arrest

KW - ECPR

KW - Meta-analysis

KW - Outcome

UR - http://www.scopus.com/inward/record.url?scp=85201376745&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2024.110357

DO - 10.1016/j.resuscitation.2024.110357

M3 - Journal article

C2 - 39142468

SN - 0300-9572

VL - 202

JO - Resuscitation

JF - Resuscitation

M1 - 110357

ER -

Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: an individual pooled patient data meta-analysis

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Keywords

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