A Scoping Review on The Use of Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-Of-Hospital Cardiac Arrest

Abstract

Aim of the review: To provide an overview of studies that have published data regarding region and population size, procedure location, team composition, inclusion and exclusion criteria, outcome parameters, and cost–benefit analyses on extracorporeal membrane oxygenation use for refractory out-of-hospital cardiac arrest. Data sources: A structured systematic literature search of articles published prior to April 27, 2021, was performed in online databases (PubMed, EMBASE, ClinicalTrials.gov, the EU Clinical Trials Register, and Cochrane Library). Results: Sixty-three articles were included based on predefined eligibility criteria. The included articles were published between 2011 and 2021, with the highest number of articles in 2020 and 2021 (50%). Of the 58 articles that reported data on organisational topics, 47 reported transporting the patients to the hospital for cannulation, 10 reported initiating extracorporeal cardiopulmonary resuscitation (ECPR) on-scene, and one reported doing both. The most common inclusion criterion was a lower age limit of 18 years (in 86% of the articles). Other inclusion criteria were witnessed collapse (67%) and initial ventricular fibrillation/tachycardia (43%), asystole (3%), pulseless electrical activity (5%), pulmonary embolism (2%), and signs of life during CPR (5%). The most common exclusion criterion was a do-not-resuscitate order (38%). Of the 44 studies reporting outcomes, 77% reported survival to hospital discharge and 50%, a cerebral performance category score of 1-2. Other outcome parameters were sparsely reported. Conclusion: There is a variation in regional size, team composition, inclusion and exclusion criteria and reported outcomes. These discrepancies make it challenging to determine how to effectively use ECPR.