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Predictors of Survival and Favorable Neurologic Outcome in Patients Treated with eCPR: a Systematic Review and Meta-analysis

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A Correction to this article was published on 15 March 2022

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Abstract

Extracorporeal cardiopulmonary resuscitation (eCPR) can improve survival in selected patients with cardiac arrest (CA). In this meta-analysis, we evaluated factors associated with short-term survival and favorable neurologic outcome (FNO) post-eCPR. In June 2019, we systematically searched electronic databases for studies reporting on survival and predictors associated with short-term survival or FNO post-eCPR using multivariable analysis. We meta-analyzed outcomes and predictors using the inverse variance method with a random-effects model. We identified 92 studies with 13 factors amenable to meta-analysis. Pooled short-term survival and FNO were 25% and 16% respectively. Lower lactate, return of spontaneous circulation, shockable rhythm, shorter CPR duration, baseline pH, shorter low-flow time, and history of hypertension were significantly associated with short-term survival. In addition, shockable rhythm, lower lactate, and use of targeted temperature management were associated with FNO. The identified factors associated with short-term survival and FNO post-eCPR could guide prognosis prediction at the time of CA.

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Abbreviations

AMI:

Acute myocardial infarction

CA:

Cardiac arrest

CPR:

Cardiopulmonary resuscitation

CS:

Cardiogenic shock

ELSO:

Extracorporeal Life Support Organization

IHCA:

In-hospital cardiac arrest

QUIPS:

Quality in Prognosis Studies

MCS:

Mechanical circulatory support

OHCA:

Out of hospital cardiac arrest

ROSC:

Return of spontaneous circulation

TTM:

Targeted temperature management

VA-ECMO:

Veno-arterial extracorporeal membrane oxygenation

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Funding

Dr. Billia receives funding by the Canadian Institutes for Health Research Clinician-Scientist Program.

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Authors and Affiliations

  1. Ted Rogers Center for Heart Research, Toronto, Canada

    Mia Bertic, Mali Worme, Farid Foroutan, Vivek Rao, Filio Billia & Ana C. Alba

  2. Division of Cardiology, Peter Munk Cardiac Center, Toronto, Canada

    Mia Bertic, Mali Worme, Filio Billia & Ana C. Alba

  3. Division of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada

    Vivek Rao

Authors
  1. Mia Bertic
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Correspondence to Mia Bertic.

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Ethical Approval.

No human studies were carried out by the authors for this article. No animal studies were carried out by the authors for this article.

Competing Interests

Dr. Vivek Rao is a consultant to Medtronic, Gore, and Abbott; serves on the Surgical Advisory board to Medtronic; and has an equity interest in Medtronic (minor < $25 k). The rest of the authors have no disclosures to state.

*Median and IQR values reported unless otherwise stated. Values reported represent the median of values taken from each study unless otherwise stated. **Population type unknown in 6 studies.

A. Too few: too few studies to interpret Funnel Plots.

B. Large effect defined as: OR > 1.5 or OR < 0.7.

C. *Although serious risk of bias on initial assessment, there was no significant difference between studies with high risk of bias and those without, thus risk of bias conclusion was “not serious.”

D. Imprecision was deemed serious if the 95%CI overlapped 1.

E. Inconsistency was judged based on similarity of point of estimates, extent of overlap of confidence intervals, and statistical criteria including tests of heterogeneity and I2.

F. Age (per year increase); CPR duration (per minute increase); Low-flow time (per minute increase); pH (mean baseline); Lactate (per 1 mmol/L increase); Hypertension (history of).

Additional information

Associate Editor Navin Kumar Kapur oversaw the review of this article.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Mia Bertic and Mali Worme are co-first authors.

Filio Billia and An a C Alba are co-senior authors.

The original version of this article was revised: An incorrect version of Table 2 was presented in this article as originally published and has been replaced.

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Bertic, M., Worme, M., Foroutan, F. et al. Predictors of Survival and Favorable Neurologic Outcome in Patients Treated with eCPR: a Systematic Review and Meta-analysis. J. of Cardiovasc. Trans. Res. 15, 279–290 (2022). https://doi.org/10.1007/s12265-021-10195-9

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