title: Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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 I2statistic.
  
  
  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.
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Dagmar M
authors.initials: DM
authors.lastname: Ouweneel
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Jasper V
authors.initials: JV
authors.lastname: Schotborgh
authors.affiliation: Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Limpens
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Krischan D
authors.initials: KD
authors.lastname: Sjauw
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Engström
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wim K
authors.initials: WK
authors.lastname: Lagrand
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thomas G V
authors.initials: TGV
authors.lastname: Cherpanath
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Antoine H G
authors.initials: AHG
authors.lastname: Driessen
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Bas A J M
authors.initials: BAJM
authors.lastname: de Mol
authors.affiliation: AMC Heart Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.p.henriques@amc.uva.nl.
authors.forename: José P S
authors.initials: JPS
authors.lastname: Henriques
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Cardiac arrest; Cardiogenic shock; Cardiopulmonary resuscitation; Extracorporeal life support; Extracorporeal membrane oxygenation; Systematic review