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.
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.