Abstract Details

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

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S2 - Neurocritical Care (2:28 PM-2:39 PM)

Poster/Presentation
Number 009

Background ECPR is a recognized treatment of cardiac arrest refractory to conventional cardiopulmonary resuscitation (CCPR).

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).

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.

Authors/Disclosures
Ibrahim Migdady, MD PRESENTER	Dr. Migdady has nothing to disclose.
Cory J. Rice, MD (Erlanger Health System)	No disclosure on file
Ken Uchino, MD (Cleveland Clinic Foundation)	Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.
Sung M. Cho, DO (Johns Hopkins Hospital)	Dr. Cho has nothing to disclose.

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