Extra-corporeal-cardiopulmonary-resuscitation vs. conventional-cardiopulmonary-resuscitation: an in-depth look into short- and long-term neurological outcomes

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is a new approach for cardiac arrest management and is regarded as a possible alternative for conventional cardiopulmonary resuscitation (cCPR). Aim: Our systematic review and meta-analysis seek to compare outcomes of cCPR versus eCPR in patients with out-of-hospital cardiac arrest (OHCA). Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this study and the questionnaire utilized the PICO (Patient, Intervention, Control, Outcome) framework. A search strategy using MeSH (Medical Subject Headings) terms was made from which Pubmed/Medline, SCOPUS, and Cochrane Library were searched from inception till March 2024 to reveal all relevant studies. Conference proceedings, www.clinicaltrials.gov, and bibliometrics of published articles were also searched for gray literature. Results: Compared with conventional CPR (cCPR), extracorporeal CPR (eCPR) was associated with higher odds of favorable neurological outcome at discharge (OR 2.61, 95% CI 1.28–5.32; p = 0.008; I²=82%), 3-months (OR 3.29, 95% CI 1.63–6.63; p = 0.0009; I²=46%), and 6-months (OR 1.97, 95% CI 1.24–3.12; p = 0.004; I²=12%). The increase at 1-month was not significant (OR 2.15, 95% CI 0.87–5.34; p = 0.10; I²=90%). eCPR also improved survival-to-discharge (OR 1.84, 95% CI 1.17–2.92; p = 0.009; I²=73%). Conclusion: eCPR in the management of OHCA patients has more favorable neurological and survival outcomes as compared to cCPR.