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2016 ; 42
(12
): 1922-1934
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Extracorporeal life support during cardiac arrest and cardiogenic shock: a
systematic review and meta-analysis
#MMPMID27647331
Intensive Care Med
2016[Dec]; 42
(12
): 1922-1934
PMID27647331
show ga
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.
|Extracorporeal Membrane Oxygenation/*methods/mortality/statistics & numerical
data
[MESH]