title: Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis.
abstract: The objective was to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), when compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients, and to determine appropriate conditions that can predict good survival outcome in ECPR patients through a meta-analysis.
  
  
  
  We searched the relevant literature of comparative studies between ECPR and CCPR in adults, from the MEDLINE, EMBASE, and Cochrane databases. The baseline information and outcome data (survival, good neurologic outcome at discharge, at 3-6 months, and at 1 year after arrest) were extracted. Beneficial effect of ECPR on outcome was analyzed according to time interval, location of arrest (out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA)), and pre-defined population inclusion criteria (witnessed arrest, initial shockable rhythm, cardiac etiology of arrest and CPR duration) by using Review Manager 5.3. Cochran's Q test and I(2) were calculated.
  
  
  
  10 of 1583 publications were included. Although survival to discharge did not show clear superiority in OHCA, ECPR showed statistically improved survival and good neurologic outcome as compared to CCPR, especially at 3-6 months after arrest. In the subgroup of patients with pre-defined inclusion criteria, the pooled meta-analysis found similar results in studies with pre-defined criteria.
  
  
  
  Survival and good neurologic outcome tended to be superior in the ECPR group at 3-6 months after arrest. The effect of ECPR on survival to discharge in OHCA was not clearly shown. As ECPR showed better outcomes than CCPR in studies with pre-defined criteria, strict indications criteria should be considered when implementation of ECPR.
authors: Department of Emergency Medicine, College of Medicine, Korea University Hospital, Seoul, Republic of Korea.
authors: Su Jin
authors: SJ
authors: Kim
authors: Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
authors: Hyun Jung
authors: HJ
authors: Kim
authors: Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
authors: Hee Young
authors: HY
authors: Lee
authors: Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
authors: Hyeong Sik
authors: HS
authors: Ahn
authors: Department of Emergency Medicine, College of Medicine, Korea University Hospital, Seoul, Republic of Korea. Electronic address: kuedlee@korea.ac.kr.
authors: Sung Woo
authors: SW
authors: Lee
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cerebral performance category; Conventional cardiopulmonary resuscitation; Extracorporeal cardiopulmonary resuscitation; In-hospital cardiac arrest; Meta-analysis; Out-of-hospital cardiac arrest