Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising intervention for refractory cardiac arrest, offering circulatory support when conventional CPR (CCPR) fails. While survival benefits have been reported, its impact on neurological outcomes remains uncertain. This meta-analysis evaluates the effectiveness of ECPR versus CCPR in achieving favorable neurological outcomes 30 days post-hospital discharge.
Methods: A systematic review was conducted to identify comparative studies of adult patients undergoing ECPR versus CCPR from different databases, published between 2019-2024. Eight studies met inclusion criteria. The primary endpoint was a favorable neurological outcome at 30 days post-discharge. Pooled hazard ratios (HRs) were calculated using a random-effects model. Heterogeneity was assessed using I² statistics. Artificial Intelligence assist tools were used for improving fluidity, grammar and structure of the writing, not included in data curation, analysis and interpretation.
Results: A total of eight studies were included, with a median patient age of 52 years (ECPR) vs 55.6 years (CCPR), and a predominantly male population (64% ECPR vs 68.2% CCPR). ECPR was associated with a significantly higher rate of favorable neurological outcomes at 30 days, with a pooled hazard ratio of 0.62 [95% CI: 0.54–0.71; p < 0.0001], indicating a 38% reduction in poor neurological outcomes. Heterogeneity was low (I² = 0%, p = 0.47), and the prediction interval [0.53–0.74] supports consistent benefit across diverse clinical settings. Survival was also improved in the ECPR group (15.6%) compared to CCPR (8.2%) though was not significant (p < 0.23)
Conclusions: ECPR improves 30-day neurological outcomes and survival in adult patients with refractory cardiac arrest compared to CCPR. These findings highlight the clinical utility of ECPR, particularly with early recognition, prompt ECMO initiation, and specialized team involvement. Further prospective studies are warranted to improve patient selection and assess long-term functional and cognitive outcomes.
