AI Article Synopsis

  • Veno-arterial extracorporeal life support (ECLS) is being increasingly used in patients experiencing cardiac arrest and cardiogenic shock, and a systematic review was conducted to analyze its effectiveness compared to standard treatment.
  • The review included 13 cohort studies, showing that ECLS significantly improved 30-day survival rates and neurological outcomes in cardiac arrest patients and also led to higher survival rates in cardiogenic shock patients when compared to intra-aortic balloon pumps (IABP).
  • The findings indicate that ECLS is beneficial in enhancing survival and neurological recovery in cardiac arrest cases and may offer advantages over IABP in cardiogenic shock scenarios.

Article 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 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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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106498PMC
http://dx.doi.org/10.1007/s00134-016-4536-8DOI Listing

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