A Systematic Review with Meta-Analysis Investigating the Impact of Targeted Perfusion Parameters during Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital and Inhospital Cardiac Arrest.
J Extra Corpor Technol
; 54(3): 191-202, 2022 Sep.
Article
em En
| MEDLINE
| ID: mdl-36742214
ABSTRACT
Evidence regarding perfusion conditions during extracorporeal cardiopulmonary resuscitation (ECPR) is rare. Therefore, we investigated the impact of perfusion parameters on neurologic outcome and survival in patients with in- or out-of-hospital cardiac arrest (IHCA; OHCA) treated with ECPR. We performed a systematic review with meta-analysis. The focus was set on perfusion parameters and their impact on survival and a goal neurological outcome using the cerebral performance category score of 1-2. We conducted random- and mixed-effects meta-analyses and computed pooled estimates and 95% confidence intervals (CI). We included a total of n = 1,282 ECPR (100%) patients from 20 ECPR studies. The target values of flow and mean arterial pressure (MAP) were frequently available. We transferred flow and MAP target values to high, medium, and low categories. The meta-analysis could not demonstrate a single effect of flow or MAP on outcome variables. In a second mixed-effects model, the combined occurrence of targeted flow and MAP as medium and high showed a significant effect on survival (OHCA 52%, 95% CI 29%, 74%; IHCA 60%, 95% CI 35%, 85%) and on neurological outcomes (OHCA 53%, 95% CI 27%, 78%; IHCA 62%, 95% CI 38%, 86%). Random-effects analysis showed also that IHCA led to a significant 11% (p = 0.006; 95% CI 3%, 18%) improvement in survival and 12% (p = .005; 95% CI 4%, 21%) improvement in neurological outcomes compared to OHCA. A combination of medium flow and high MAP showed advantages in survival and for neurological outcomes. We also identified improved outcomes for IHCA.
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Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Oxigenação por Membrana Extracorpórea
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Reanimação Cardiopulmonar
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Parada Cardíaca Extra-Hospitalar
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
J Extra Corpor Technol
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Alemanha