Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

Dagmar M Ouweneel, Jasper V Schotborgh, Jacqueline Limpens, Krischan D Sjauw, A E Engström, Wim K Lagrand, Thomas G V Cherpanath, Antoine H G Driessen, Bas A J M de Mol, José P S Henriques, Dagmar M Ouweneel, Jasper V Schotborgh, Jacqueline Limpens, Krischan D Sjauw, A E Engström, Wim K Lagrand, Thomas G V Cherpanath, Antoine H G Driessen, Bas A J M de Mol, José P S Henriques

Abstract

Purpose: Veno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest and cardiogenic shock, to support both cardiac and pulmonary function. We performed a systematic review and meta-analysis of cohort studies comparing mortality in patients treated with and without ECLS support in the setting of refractory cardiac arrest and cardiogenic shock complicating acute myocardial infarction.

Methods: We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed updated to December 2015. Thirteen studies were included of which nine included cardiac arrest patients (n = 3098) and four included patients with cardiogenic shock after acute myocardial infarction (n = 235). Data were pooled by a Mantel-Haenzel random effects model and heterogeneity was examined by the I 2 statistic.

Results: In cardiac arrest, the use of ECLS was associated with an absolute increase of 30 days survival of 13 % compared with patients in which ECLS was not used [95 % CI 6-20 %; p < 0.001; number needed to treat (NNT) 7.7] and a higher rate of favourable neurological outcome at 30 days (absolute risk difference 14 %; 95 % CI 7-20 %; p < 0.0001; NNT 7.1). Propensity matched analysis, including 5 studies and 438 patients (219 in both groups), showed similar results. In cardiogenic shock, ECLS showed a 33 % higher 30-day survival compared with IABP (95 % CI, 14-52 %; p < 0.001; NNT 13) but no difference when compared with TandemHeart/Impella (-3 %; 95 % CI -21 to 14 %; p = 0.70; NNH 33).

Conclusions: In cardiac arrest, the use of ECLS was associated with an increased survival rate as well as an increase in favourable neurological outcome. In the setting of cardiogenic shock there was an increased survival with ECLS compared with IABP.

Keywords: Acute myocardial infarction; Cardiac arrest; Cardiogenic shock; Cardiopulmonary resuscitation; Extracorporeal life support; Extracorporeal membrane oxygenation; Systematic review.

Conflict of interest statement

Compliance with ethical standards Conflicts of interest J.P.S. Henriques reports research grants outside the submitted work. The other authors do not declare any conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the search strategy and selection of studies. Asterisk: 1 article reported on the same patient cohort as another included article, but provided additional data on propensity-matched analysis and was therefore included
Fig. 2
Fig. 2
Risk difference of 30-day survival (a) and favourable neurologic outcome (CPC 1 or 2) (b) and propensity-matched risk difference in 30-day survival (c) and favourable neurologic outcome (CPC 1 or 2) (d) in patients with cardiac arrest
Fig. 3
Fig. 3
Difference of 30-day survival of patients with cardiogenic shock, stratified according to different control therapies (IABP or Impella/TandemHeart)

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