title: Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis.
abstract: Association estimates between baseline characteristics and outcomes are imprecise and inconsistent among extracorporeal cardiopulmonary resuscitation (ECPR) recipients following refractory out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis aimed to investigate the prognostic significance of pre-specified characteristics for OHCA treated with ECPR.
  
  
  
  The Medline electronic database was searched via PubMed for articles published from January 2000 to September 2016. The electronic search was supplemented by scanning the reference lists of retrieved articles and contacting field experts. Eligible studies were historical and prospective cohort studies of adult patients undergoing ECPR following OHCA.
  
  
  
  Fifteen primary studies were included, totaling 841 participants. The median prevalence of the primary outcome (i.e., short- or long-term survival for five studies and cerebral performance for ten studies) was 15% (range, 0-50%). The primary outcome was associated with an increased odds ratio of initial shockable cardiac rhythm (2.20; 95% confidence interval [CI], 1.30-3.72; P=0.003), shorter low-flow duration (geometric mean ratio, 0.90; 95% CI, 0.81-0.99; P=0.04), higher arterial pH value (difference, 0.12; 95% CI, 0.03-0.22; P=0.01) and lower serum lactate concentration (difference, -3.52mmol/L; 95% CI, -5.05 to -1.99; P<0.001). No significant association was found between the primary outcome and patient age (the odds of female gender and bystander CPR attempt.
  
  
  
  Observational evidence from published primary studies indicates that shorter low-flow duration, shockable cardiac rhythm, higher arterial pH value and lower serum lactate concentration on hospital admission are associated with better outcomes for ECPR recipients after OHCA.
authors.affiliation: University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France. Electronic address: gdebaty@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Babaz
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Durand
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Gaide-Chevronnay
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Fournel
authors.affiliation: Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Blancher
authors.affiliation: Department of Cardiology, University Hospital of Grenoble Alps, Grenoble, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.affiliation: Department of Cardiac Surgery, University Hospital of Grenoble Alps, Grenoble, France; HP2 Laboratory, INSERM U 1042, Grenoble, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chavanon
authors.affiliation: Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, France; HP2 Laboratory, INSERM U 1042, Grenoble, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Maignan
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France; University Grenoble Alps, Grenoble Institut des Neurosciences, Grenoble F-38042, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.affiliation: University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alps, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: University Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble F-38041, France; Quality of Care Unit, INSERM CIC1406, University Hospital of Grenoble Alps, Grenoble, France.
authors.forename: José
authors.initials: J
authors.lastname: Labarère
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019344:Lactic Acid
keywords: Adult; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Out-of-hospital cardiac arrest; Prognosis