Neurological outcomes of Extracorporeal Cardiopulmonary Resuscitation (ECPR): A Systematic Review

Objective: We performed a systematic review of the recent literature to analyze the patients’ characteristics, indications, survival and neurological outcomes associated with Extracorporeal Cardiopulmonary Resuscitation (ECPR). Background: ECPR is a recognized treatment of cardiac arrest refractory to conventional cardiopulmonary resuscitation (CCPR). Design/Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Embase, Cochrane, CINAHL, Scopus, Web of Science, and ClinicalTrials.gov for observational studies and randomized clinical trials (RCTs) reporting neurological outcomes of adult patients receiving ECPR for cardiac arrest. Results: Of 3626 studies screened, 59 met the inclusion criteria; including 1 RCT and 58 observational studies (5 prospective and 53 retrospective) totaling 6053 patients; of which 3725 (62%) received ECPR. In ECPR patients, the median age was 55 years (IQR 51–59), 72% were male, 51% had out-of-hospital cardiac arrest and 40% had initial shockable heart rhythm. Etiology of cardiac arrest was reported in 2796 patients; the commonest was acute coronary syndrome (49%), post-cardiotomy (6%), cardiomyopathy or heart failure (6%), arrhythmia (4%), myocarditis (2%), post-transplant failure (0.3%) and other (28%). The overall medians of CCPR and ECPR duration were 50.8 minutes (IQR 36–62) and 3.2 days (IQR 2–5.3); respectively. The median prevalence (IQR) of ischemic stroke, intracranial hemorrhage, anoxic brain injury and brain death were 2% (0–2.8), 4% (1.4–11.8), 18% (10–23.2) and 21% (11.3–25.3); respectively. Overall, 600 patients (16%) survived to discharge (median 29.7%; IQR 24.1–34.8), and 559 (15%) were discharged with CPC 1 or 2 (median 26%; IQR 17.5–37.6). The median mortality due to neurological complications was 14.2% (IQR 9–21). Conclusions: Neurological complications remain key determinants of outcomes in patients with ECPR. There is a dire need for RCTs and prospective studies assessing predictors and preventive methods of these complications; this systematic review and the future meta-analysis will serve as a comprehensive reference for future studies in the field. Disclosure: Dr. Migdady has nothing to disclose. Dr. Rice has nothing to disclose. Dr. Uchino has nothing to disclose. Dr. Cho has nothing to disclose.