Extracorporeal Cardiopulmonary Resuscitation for Prehospital Cardiac Arrest Patients: A Systematic Review

Abstract

Abstract

Background: Despite the improvements in critical care services in the recent decade, the mortality and the morbidity associated with out-of-hospital cardiac arrest is still high. One of the approaches to improve the outcome of this group of patients is the use of Extracorporeal cardiopulmonary resuscitation Devices (ECPR). However, there are conflicting reports in the literature about the short- and long-term benefits of this approach.

Aim: The aim of this review is to systematically assess the relevant literature available online regarding the effectiveness and safety of the use of ECPR in out-of- hospital cardiac arrest patients (OHCA). Method: Four online scientific databases (PubMed, Embase, Medline, and Co- chrane) will be screened for relevant articles with specific inclusion and exclusion criteria that involve assessing the use of ECPR in out-of-hospital non-traumatic car- diac arrest patients vs. the use of standard of care cardiopulmonary resuscitation (CPR). The included articles will be checked for possible sources of bias and finally the relevant information will be presented using a thematic approach discussing the key themes related to the effectiveness of ECPR in a both descriptive and analytical manner.

Results: Out of 5,090 articles screened, 28 were selected for this review. Three of these articles were clinical trials, while the rest were observational studies, most of which were retrospective or prospective cohort studies. An evident (two- to three- fold) increase was observed in the hospital survival rate in the ECPR group when compared with the CPR-only group. Furthermore, short- and long-term neurological status was improved in most of the reviewed evidence (26% to 40% and 12% to 40%, respectively). However, some studies showed contradicting results, with the CPR group having a better survival rate and fewer short- and long-term neurological

complications. Conclusion: The use of ECPR in OHCA patients improves the survival and the neurological status of the involved patient. However, larger randomized clinical trials need to be done to confirm this result.