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Open Access 01-12-2016 | Systematic Review

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

Authors: 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

Published in: Intensive Care Medicine | Issue 12/2016

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.

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Title: Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis
Authors: 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
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4536-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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