Impact of prehospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest on survival with good neurological function: a systematic review and meta-analysis.

Abstract

<h4>Aim</h4>Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) has been proposed to reduce delays in ECPR delivery in refractory out-of-hospital cardiac arrests (OHCA) and improve outcomes. Our aim was to synthesize the literature on outcomes of prehospital ECPR in OHCA, focusing on low-flow times (emergency call to extracorporeal blood flow) and survival with good neurological function, comparing them to in-hospital ECPR when possible.<h4>Methods</h4>We conducted a systematic review and <i>meta</i>-analysis of studies reporting outcomes in adult OHCA patients treated with prehospital ECPR. Searches spanned seven databases and relevant grey literature (last updated January 21, 2025). Eligible studies included ≥ 5 patients. The primary outcome was survival with good neurological function (CPC 1-2). Pooled estimates were calculated using random-effects models. Meta-regression assessed the association between low-flow time and survival. Comparative analyses with in-hospital ECPR were performed when possible.<h4>Results</h4>Eight cohort studies involving 305 patients (84% male, mean age 57) were included. Survival with good neurological function was 25% (95%CI: 17-35%). Mean low-flow time was 59 min (95%CI: 46-72). Meta-regression showed a significant inverse association between low-flow time and good neurological outcomes (β = -0.0271, 95%CI: -0.0536 to -0.0006; p = 0.045). Compared to in-hospital ECPR, prehospital ECPR showed no significant difference in survival (RR 1.23, 95%CI: 0.35-4.38) but was associated with significantly shorter low-flow times (mean difference -30 min, 95%CI: -44 to -16).<h4>Conclusion</h4>Prehospital ECPR is associated with a 25% rate of survival with good neurological function. Shorter low-flow times were associated with improved outcomes.