(P044) THE UTILITY OF EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION FOR PATIENTS WHO SUFFER AN OUT OF HOSPITAL CARDIAC ARREST COMPARED WITH IN HOSPITAL CARDIAC ARREST: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Extracorporeal Cardiopulmonary Resuscitation (ECPR) represents a novel intervention in the management of patients who suffer a cardiac arrest. ECPR utilizes extracorporeal membrane oxygenation (ECMO) to maintain cardiopulmonary function when standard CPR cannot restore circulation during cardiac arrest. ECPR has shown promise in improving survival rates in select patient populations through altering emergency cardiovascular management paradigms. Comparative data between the use of ECPR for patients with an out-of-hospital cardiac arrest (OOHCA) versus an in-hospital cardiac arrest (IHCA) remain sparse. This systematic review and meta-analysis aim to delineate the differential outcomes and factors associated with survival with ECPR interventions in these two distinct yet similar settings.

METHODS AND RESULTS: A systematic literature search of medical databases and grey literature using PRISMA principles identified all relevant studies comparing the use of ECPR in association with IHCA compared to OHCA (2000-2024; English Only; PROSPERO registration CRD42024520780). See Figure 1. Data for all variables were extracted and those with low heterogeneity were then meta-analyzed using a random-effect model for odds ratio (OR) or standardized mean differences (SMD). See Table 1. A total of 13 studies were identified, with 438 patients in the IHCA group and 316 patients in the OOHCA group treated with ECPR. Our meta-analysis demonstrates that in patients who were started on ECPR, the OOHCA group was more likely to have an underlying cardiac cause for the arrest (OR 0.483, CI 0.248 – 0.941, p=0.03) and subsequently underwent urgent coronary angiography (OR 0.414, CI 0.229 – 0.746, p=0.003) with primary percutaneous intervention (OR 0.322, CI 0.138 - 0.754, p=0.009). In comparison of the two populations, there were comparable mortality rates (OR 1.390, CI 0.363 – 2.730, p=0.992), cerebral performance category scores (OR 1.684, CI 0.697 – 4.070, p=0.247) and uptake of left ventricular assist device therapies (OR 2.865, CI 0.492 – 16.679, p=0.242).

Conclusion: This meta-analysis demonstrates that in patients who are started on ECPR, OOHCA cohorts more likely had a reversible cardiac cause for their arrest. Despite therapies provided, survival to discharge and neurological recovery was similar between the two populations.