Predictors of Mortality in Patients with Cardiac Arrest Treated with ECPR

Abstract

Purpose Cardiac arrest portends a poor prognosis with survival rates of 10% for out-of hospital cardiac arrest (OHCA) and 25% for in-hospital cardiac arrest (IHCA). Despite resuscitation efforts, only a small proportion of patients survive. Extracorporeal cardiopulmonary resuscitation (eCPR) has the potential to restore circulation in an attempt to improve survival. However, it is essential to balance the potential benefit of eCPR against its futility. This systematic review and meta-analysis aimed to identify factors associated with higher short-term mortality post-eCPR. Methods We searched electronic databases for full text or abstracts of observational studies or post-hoc analysis of randomized controlled trials reporting factors associated with short-term mortality after eCPR using multivariable analysis. We included studies on adults aged 18 years or older with IHCA or OHCA, published after 2009. Studies that included post-cardiotomy, septic shock, respiratory failure or refractory cardiogenic shock were excluded. We performed a meta-analysis of the effect of factors associated with mortality, reporting odds ratio and 95% confidence intervals (CI) using the inverse variance method with a random effects model. Results We screened a total of 14,236 citations and found 34 studies reporting on 12 factors amenable to meta-analysis. Median short-term mortality across included studies was 76% (IQR 68%-83%). Six factors were identified as significantly associated with short-term mortality: female sex [OR 0.43, 95%CI 0.28-0.85], shockable rhythm [OR 0.41, 95%CI 0.22-0.73], CPR duration [OR 1.04 per 1-minute increase, 95%CI 1.03-1.05], short low-flow time [OR 0.16 if Conclusion This meta-analysis identified several factors associated with short-term mortality in patients treated with eCPR that could be considered at the time of decision-making. Further research evaluating the combined prognostic value of these factors is warranted.