Variability in patient selection criteria across extracorporeal cardiopulmonary resuscitation (ECPR) systems: A systematic review
Alenazi, Amani Aljanoubi, Mohammed Yeung, Joyce Madan, Jason Johnson, Samantha Couper, Keith
Alenazi, Amani
Aljanoubi, Mohammed
Yeung, Joyce
Madan, Jason
Johnson, Samantha
Couper, Keith
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2024-09-24
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Abstract
Background: Across the world, many systems have implemented extracorporeal cardiopulmonary resuscitation (ECPR) as a potential treatment strategy for patients in refractory cardiac arrest. To date, there are no universally accepted criteria for patient selection for ECPR. We conducted a systematic review to explore the variability in patient eligibility criteria for ECPR across systems.
Methods: We searched the Cochrane Library(Wiley), EMBASE(OVID), and MEDLINE ALL (OVID) databases from inception to 5th February-2024 for all studies that described an ECPR system and where the system eligibility criteria was described. A combination of predetermined search terms was used to identify relevant articles. We conducted forward and backward citation tracking to identify any further relevant articles.
Results: Our search identified 12,503 articles of which 167 articles were found to be potentially eligible. Seventy-seven articles were further excluded as they described the same ECPR system as another study. We finally included 90 studies describing a total of 93 ECPR systems. The eligibility criteria for ECPR differed among the included systems. Across systems, ECPR eligibility criteria included age (n=75, 80.7%), arrest witnessed status (n=64, 68.8%), any initial rhythm (n=55, 59.1%), and bystander CPR (n=33, 35.5%). Within criteria, we observed marked variability. The age cut-off varied from 50 to 80 years, with the most common age cut-off being 75 years and 18 (19.3%) systems having no cut-off. Whilst most systems limited ECPR to shockable rhythms (n=28,30.1%), some systems included shockable rhythms and/or PEA only (n=10,10.8%).
Conclusion: We observed marked variability across systems in the eligibility criteria for potential ECPR patients. There is a need for further work to identify the optimum ECPR selection criteria.
Review registration: PROSPERO (CRD42023451109).
Citation
Alenazi A, Aljanoubi M, Yeung J, Madan J, Johnson S, Couper K. Variability in patient selection criteria across extracorporeal cardiopulmonary resuscitation (ECPR) systems: A systematic review. Resuscitation. 2024 Nov;204:110403. doi: 10.1016/j.resuscitation.2024.110403. Epub 2024 Sep 24.
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