关键词: Cardiac arrest Conventional cardiopulmonary resuscitation Extracorporeal cardiopulmonary resuscitation Extracorporeal life support Prognosis

Mesh : Humans Cardiopulmonary Resuscitation / methods Prognosis Heart Arrest / therapy mortality Extracorporeal Membrane Oxygenation / methods Out-of-Hospital Cardiac Arrest / therapy mortality

来  源:   DOI:10.1186/s12873-024-01058-y   PDF(Pubmed)

Abstract:
OBJECTIVE: Compared to the conventional cardiopulmonary resuscitation (CCPR), potential benefits of extracorporeal cardiopulmonary resuscitation (ECPR) for patients with cardiac arrest (CA) are still controversial. We aimed to determine whether ECPR can improve the prognosis of CA patients compared with CCPR.
METHODS: We systematically searched PubMed, EMBASE, and Cochrane Library from database\'s inception to July 2023 to identify randomized controlled trials (RCTs) or cohort studies that compared ECPR with CCPR in adults (aged ≥ 16 years) with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). This meta-analysis was performed using a random-effects model. Two researchers independently reviewed the relevance of the study, extracted data, and evaluated the quality of the included literature. The primary outcome was short-term (from hospital discharge to one month after cardiac arrest) and long-term (≥ 90 days after cardiac arrest) survival with favorable neurological status (defined as cerebral performance category scores 1 or 2). Secondary outcomes included survival at 1 months, 3-6 months, and 1 year after cardiac arrest.
RESULTS: The meta-analysis included 3 RCTs and 14 cohort studies involving 167,728 patients. We found that ECPR can significantly improve good neurological prognosis (RR 1.82, 95%CI 1.42-2.34, I2 = 41%) and survival rate (RR 1.51, 95%CI 1.20-1.89, I2 = 62%). In addition, the results showed that ECPR had different effects on favorable neurological status in patients with OHCA (short-term: RR 1.50, 95%CI 0.98- 2.29, I2 = 55%; long-term: RR 1.95, 95% CI 1.06-3.59, I2 = 11%). However, ECPR had significantly better effects on neurological status than CCPR in patients with IHCA (short-term: RR 2.18, 95%CI 1.24- 3.81, I2 = 9%; long-term: RR 2.17, 95% CI 1.19-3.94, I2 = 0%).
CONCLUSIONS: This meta-analysis indicated that ECPR had significantly better effects on good neurological prognosis and survival rate than CCPR, especially in patients with IHCA. However, more high-quality studies are needed to explore the role of ECPR in patients with OHCA.
摘要:
目的:与常规心肺复苏(CCPR)相比,体外心肺复苏(ECPR)对心脏骤停(CA)患者的潜在益处仍存在争议.我们旨在确定与CCPR相比,ECPR是否可以改善CA患者的预后。
方法:我们系统地搜索了PubMed,EMBASE,和Cochrane图书馆从数据库开始到2023年7月,确定了随机对照试验(RCT)或队列研究,这些试验或研究比较了成人(≥16岁)发生院外心脏骤停(OHCA)和院内心脏骤停(IHCA)的ECPR和CCPR。这项荟萃分析是使用随机效应模型进行的。两名研究人员独立审查了这项研究的相关性,提取的数据,并对纳入文献的质量进行评价。主要结局是短期(从出院到心脏骤停后1个月)和长期(心脏骤停后≥90天)生存,具有良好的神经状态(定义为脑功能类别评分1或2)。次要结果包括1个月时的生存期,3-6个月,心脏骤停后1年。
结果:荟萃分析包括3项RCT和14项队列研究,涉及167,728例患者。我们发现ECPR可以显着改善良好的神经系统预后(RR1.82,95CI1.42-2.34,I2=41%)和生存率(RR1.51,95CI1.20-1.89,I2=62%)。此外,结果显示,ECPR对OHCA患者的良好神经状态有不同的影响(短期:RR1.50,95CI0.98-2.29,I2=55%;长期:RR1.95,95%CI1.06-3.59,I2=11%).然而,ECPR对IHCA患者神经状态的影响明显优于CCPR(短期:RR2.18,95CI1.24-3.81,I2=9%;长期:RR2.17,95%CI1.19-3.94,I2=0%)。
结论:这项荟萃分析表明,ECPR对良好的神经系统预后和生存率的影响明显优于CCPR。尤其是IHCA患者。然而,需要更多高质量的研究来探讨ECPR在OHCA患者中的作用.
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