CoChat
Sign Up
Cited by 250Cardiac Arrest and ResuscitationMechanical Circulatory Support DevicesPalliative Care and End-of-Life Issues

Extracorporeal cardiopulmonary resuscitation for cardiac arrest: A systematic review

Open access
Holmberg, Mathias J., Geri, Guillaume, Wiberg, Sebastian, Guerguerian, Anne-Marie, Donnino, Michael W., Nolan, Jerry P., Deakin, Charles D., Andersen, Lars W.·2018·Resuscitation
DOI 10.1016/j.resuscitation.2018.07.029PMC PMC6441971
Open this paper in CoChat — free account

Abstract

Aim To assess the use of extracorporeal cardiopulmonary resuscitation (ECPR), compared with manual or mechanical cardiopulmonary resuscitation (CPR), for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in adults and children. Methods The PRISMA guidelines were followed. We searched Medline, Embase, and Evidence-Based Medicine Reviews for randomized clinical trials and observational studies published before May 22, 2018. The population included adult and pediatric patients with OHCA and IHCA of any origin. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the ROBINS-I tool. Outcomes included short-term and long-term survival and favorable neurological outcome. Results We included 25 observational studies, of which 15 studies were in adult OHCA, 7 studies were in adult IHCA, and 3 studies were in pediatric IHCA. There were no studies in pediatric OHCA. No randomized trials were included. Results from individual studies were largely inconsistent, although several studies in adult and pediatric IHCA were in favor of ECPR. The risk of bias for individual studies was overall assessed to be critical, with confounding being the primary source of bias. The overall quality of evidence was assessed to be very low. Heterogeneity across studies precluded any meaningful meta-analyses. Conclusions There is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies is very low.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.resuscitation.2018.07.029

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Cardiac arrest patients may meet criteria for both uncontrolled donation and E-CPR programmes.

    “Cardiac arrest patients may meet criteria for both uncontrolled donation and E-CPR programmes. 157,159,179”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [159]

    The Introduction says ECPR may be considered for select cardiac-arrest patients, and the Discussion describes ECPR patient selection (page numbers unavailable). Neither passage addresses uncontrolled donation or whether patients can meet both programmes’ criteria; searches for those terms and the claimed overlap found no supporting passage in our copy. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 49

  1. [1]Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, The extracorporeal life support organization Maastricht treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med 2018. PMC6118026 29614239
  2. [2]Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132(18 Suppl. 2): S444– 64. 26472995
  3. [3]de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132(18 Suppl. 2): S526– 42. 26473000 PMC6191296
  4. [4]Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, European Resuscitation Council Guidelines for resuscitation 2015: section 3. Adult advanced life support. Resuscitation 2015; 95: 100– 47. 26477701
  5. [5]Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 2015; 95: 223– 48. 26477414
  6. [6]Abrams D, Garan AR, Abdelbary A, Bacchetta M, Bartlett RH, Beck J, Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med 2018. 29450594
  7. [7]Riggs KR, Becker LB, Sugarman J. Ethics in the use of extracorporeal cardiopulmonary resuscitation in adults. Resuscitation 2015; 91: 73– 5. 25866287 PMC4433606
  8. [8]Richardson AS, Schmidt M, Bailey M, Pellegrino VA, Rycus PT, Pilcher DV. ECMO Cardio-Pulmonary Resuscitation (ECPR), trends in survival from an international multicentre cohort study over 12-years. Resuscitation 2017; 112: 34– 40. 27993632
  9. [9]McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, Trends in U.S. Extracorporeal membrane oxygenation use and outcomes: 2002–2012. Semin Thorac Cardiovasc Surg 2015; 27(2): 81– 8. 26686427 PMC4780346
  10. [10]Paden ML, Rycus PT, Thiagarajan RR, Registry E. Update and outcomes in extracorporeal life support. Semin Perinatol 2014; 38(2): 65– 70. 24580761
  11. [11]Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535. 19622551 PMC2714657
  12. [12]McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22(3): 276– 82. 23092060 PMC3900052
  13. [16]Agostinucci JM, Ruscev M, Galinski M, Gravelo S, Petrovic T, Carmeaux C, Out-of-hospital use of an automated chest compression device: facilitating access to extracorporeal life support or non-heart-beating organ procurement. Am J Emerg Med 2011; 29(9): 1169– 72. 20951528
  14. [17]Cesana F, Avalli L, Garatti L, Coppo A, Righetti S, Calchera I, Effects of extracorporeal cardiopulmonary resuscitation on neurological and cardiac outcome after ischaemic refractory cardiac arrest. Eur Heart J Acute Cardiovasc Care 2017. p. 29064271
  15. [18]Choi DH, Kim YJ, Ryoo SM, Sohn CH, Ahn S, Seo DW, Extracorporeal cardiopulmonary resuscitation among patients with out-of-hospital cardiac arrest. Clin Exp Emerg Med 2016; 3(3): 132– 8. 27752631 PMC5065341
  16. [19]Hase M, Tsuchihashi K, Fujii N, Nishizato K, Kokubu N, Nara S, Early defibrillation and circulatory support can provide better long-term outcomes through favorable neurological recovery in patients with out-of-hospital cardiac arrest of cardiac origin. Circ J 2005; 69(11): 1302– 7. 16247202
  17. [20]Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study. Crit Care 2014; 18(5): 535. 25255842 PMC4189722
  18. [21]Lee SH, Jung JS, Lee KH, Kim HJ, Son HS, Sun K. Comparison of extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: is extracorporeal cardiopulmonary resuscitation beneficial? Korean J Thorac Cardiovasc Surg 2015; 48(5): 318– 27. 26509125 PMC4622025
  19. [22]Maekawa K, Tanno K, Hase M, Mori K, Asai Y. Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis. Crit Care Med 2013; 41(5): 1186– 96. 23388518
  20. [23]Poppe M, Weiser C, Holzer M, Sulzgruber P, Datler P, Keferbock M, The incidence of “load&go” out-of-hospital cardiac arrest candidates for emergency department utilization of emergency extracorporeal life support: a one-year review. Resuscitation 2015; 91: 131– 6. 25779007
  21. [24]Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation 2014; 85(6): 762– 8. 24530251
  22. [25]Schober A, Sterz F, Herkner H, Wallmueller C, Weiser C, Hubner P, Emergency extracorporeal life support and ongoing resuscitation: a retrospective comparison for refractory out-of-hospital cardiac arrest. Emerg Med J 2017; 34(5): 277– 81. 28213587
  23. [26]Siao FY, Chiu CC, Chiu CW, Chen YC, Chen YL, Hsieh YK, Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation. Resuscitation 2015; 92: 70– 6. 25936930
  24. [27]Tanno K, Itoh Y, Takeyama Y, Nara S, Mori K, Asai Y. Utstein style study of cardiopulmonary bypass after cardiac arrest. Am J Emerg Med 2008; 26(6): 649– 54. 18606315
  25. [28]Venturini JM, Retzer E, Estrada JR, Friant J, Beiser D, Edelson D, Mechanical chest compressions improve rate of return of spontaneous circulation and allow for initiation of percutaneous circulatory support during cardiac arrest in the cardiac catheterization laboratory. Resuscitation 2017; 115: 56– 60. 28377296
  26. [29]Yannopoulos D, Bartos JA, Martin C, Raveendran G, Missov E, Conterato M, Minnesota resuscitation consortium’s advanced perfusion and reperfusion cardiac life support strategy for out-of-Hospital refractory ventricular fibrillation. J Am Heart Assoc 2016; 5(6). PMC4937292 27412906
  27. [30]Yannopoulos D, Bartos JA, Raveendran G, Conterato M, Frascone RJ, Trembley A, Coronary artery disease in patients with out-of-Hospital refractory ventricular fibrillation cardiac arrest. J Am Coll Cardiol 2017; 70(9): 1109– 17. 28838358
  28. [31]Blumenstein J, Leick J, Liebetrau C, Kempfert J, Gaede L, Gross S, Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: a propensity-matched analysis. Eur Heart J Acute Cardiovasc Care 2016; 5(7): 13– 22. 26503919
  29. [32]Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008; 372(9638): 554– 61. 18603291
  30. [33]Cho YH, Kim WS, Sung K, Jeong DS, Lee YT, Park PW, Management of cardiac arrest caused by acute massive pulmonary thromboembolism: importance of percutaneous cardiopulmonary support. ASAIO J 2014; 60(3): 280– 3. 24625535
  31. [34]Chou TH, Fang CC, Yen ZS, Lee CC, Chen YS, Ko WJ, An observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction. Emerg Med J 2014; 31(6): 441– 7. 24107999
  32. [35]Lin JW, Wang MJ, Yu HY, Wang CH, Chang WT, Jerng JS, Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: propensity analysis of three-year data. Resuscitation 2010; 81(7): 796– 803. 20413202
  33. [36]Shin TG, Choi JH, Jo IJ, Sim MS, Song HG, Jeong YK, Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: a comparison with conventional cardiopulmonary resuscitation. Crit Care Med 2011; 39(1): 1– 7. 21057309
  34. [37]Shin TG, Jo IJ, Sim MS, Song YB, Yang JH, Hahn JY, Two-year survival and neurological outcome of in-hospital cardiac arrest patients rescued by extracorporeal cardiopulmonary resuscitation. Int J Cardiol 2013; 168(4): 3424– 30. 23664696
  35. [38]Lasa JJ, Rogers RS, Localio R, Shults J, Raymond T, Gaies M, Extracorporeal Cardiopulmonary Resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association’s Get With The Guidelines-Resuscitation (GWTG-R) registry. Circulation 2016; 133(2): 165– 76. 26635402 PMC4814337
  36. [39]Odegard KC, Bergersen L, Thiagarajan R, Clark L, Shukla A, Wypij D, The frequency of cardiac arrests in patients with congenital heart disease undergoing cardiac catheterization. Anesth Analg 2014; 118(1): 175– 82. 23749445
  37. [40]Ortmann L, Prodhan P, Gossett J, Schexnayder S, Berg R, Nadkarni V, Outcomes after in-hospital cardiac arrest in children with cardiac disease: a report from Get With the Guidelines–Resuscitation. Circulation 2011; 124(21): 2329– 37. 22025603
  38. [41]Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ, Inhospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med 2009; 37(7): 2259– 67. 19455024 PMC2711020
  39. [42]Fredriksson M, Aune S, Bång A, Thorén AB, Lindqvist J, Karlsson T, Cardiac arrest outside and inside hospital in a community: mechanisms behind the differences in outcome and outcome in relation to time of arrest. Am Heart J 2010; 159(5): 749– 56. 20435182
  40. [43]Engsig M, Søholm H, Folke F, Gadegaard PJ, Wiis JT, Molin R, Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management. Clin Epidemiol 2016; 8: 761– 8. 27877067 PMC5108475
  41. [44]Moskowitz A, Holmberg MJ, Donnino MW, Berg KM. In-hospital cardiac arrest: are we overlooking a key distinction? Curr Opin Crit Care 2018; 24(3): 151– 7. 29688939 PMC6007985
  42. [45]Singer B, Reynolds JC, Lockey DJ, O’Brien B. Pre-hospital extra-corporeal cardiopulmonary resuscitation. Scand J Trauma Resusc Emerg Med 2018; 26(1): 21. 29587810 PMC5870373
  43. [46]Andersen LW, Grossestreuer AV, Donnino MW. “Resuscitation time bias”-a unique challenge for observational cardiac arrest research. Resuscitation 2018; 125: 79– 82. 29425975 PMC6080954
  44. [48]Harvey MJ, Gaies MG, Prosser LA. U.S. and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review. Appl Health Econ Health Policy 2015; 13(4): 341– 57. 25894740
  45. [49]D’Arrigo S, Cacciola S, Dennis M, Jung C, Kagawa E, Antonelli M, Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation 2017; 121: 62– 70. 29020604
  46. [50]Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation 2017; 112: 1– 10. 28007504
  47. [51]Yuan-Hsi T, Meng-Yu W, Feng-Chun T, Hai-Jing C, Pyng Jing L. Costs associated with extracorporeal life support used in adults: a single-center study. Acta Cardiol Sin 2011; 27: 221– 8.
  48. [52]St-Onge M, Fan E, Mégarbane B, Hancock-Howard R, Coyte PC. Venoarterial extracorporeal membrane oxygenation for patients in shock or cardiac arrest secondary to cardiotoxicant poisoning: a cost-effectiveness analysis. J Crit Care 2015; 30(2). p. 437. 25454073
  49. [53]Mahle WT, Forbess JM, Kirshbom PM, Cuadrado AR, Simsic JM, Kanter KR. Costutility analysis of salvage cardiac extracorporeal membrane oxygenation in children. J Thorac Cardiovasc Surg 2005; 129(5): 1084– 90. 15867784

Cited by

Sorted by citations

Authors
Holmberg, M. J., Geri, G., Wiberg, S., Guerguerian, A.-M., Donnino, M. W., Nolan, J. P., Deakin, C. D., & Andersen, L. W.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • University of Toronto (CA)
  • University of Bristol (GB)
  • NIHR Southampton Respiratory Biomedical Research Unit (GB)
Corresponding author
Andersen, Lars W.
ORCID
Venue
Resuscitation
Publisher
Elsevier BV
Published
2018-10
Volume
131
Pages
91-100
ISSN
0300-9572 (ISSN-L)
DOI
10.1016/j.resuscitation.2018.07.029
PMC
PMC6441971
OpenAlex
W2884056107
Cited by
250
References
3
Citations by year
2026: 12 · 2025: 12 · 2024: 26 · 2023: 31 · 2022: 29 · 2021: 52 · 2020: 56 · 2019: 27 · 2018: 5
FWCI
8.74
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Resuscitation (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (K24HL127101, R01HL136705)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
extracorporeal cardiopulmonary resuscitation, out-of-hospital cardiac arrest, in-hospital cardiac arrest, mechanical CPR, survival, neurological outcome, pediatric cardiac arrest
MeSH terms
Humans, Extracorporeal Membrane Oxygenation, Cohort Studies, Randomized Controlled Trials as Topic, Cardiopulmonary Resuscitation, Outcome Assessment, Health Care, Out-of-Hospital Cardiac Arrest, Observational Studies as Topic, Non-Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review