体外心肺复苏应用于心脏骤停患者神经功能预后的系统评价和Meta分析

Systematic evaluation and Meta analysis of the prognosis of neurological function in cardiac arrest patients with the application of extracorporeal cardiopulmonary resuscitation

目的通过系统评价探讨体外膜肺氧合(ECMO)辅助下心肺复苏(CPR)对心脏骤停(CA)患者神经功能预后的影响。方法检索从建库至2023年2月PubMed、Web of Science、Ovid、Cochrane Library、中国知网、万方数据库、中华医学期刊全文数据库、中国生物医学文献数据库等。根据文献纳入和排除标准进行文献筛选、质量评价和资料提取,应用RevMan 5.3软件进行统计分析。结果共纳入9项研究,共计2694例患者,其中体外心肺复苏(ECPR)组717例患者,传统心肺复苏(CCPR)组1977例。Meta分析结果显示,与CCPR相比,ECPR可以提高CA患者短期(出院或1个月内)神经功能预后[OR=2.93,95%CI(1.76,4.87),P<0.0001]及长期神经功能预后[OR=0.12,95%CI(0.07,0.17),P<0.00001]。亚组分析表明,在院内心脏骤停(IHCA)和院外心脏骤停(OHCA)患者中实施ECPR对改善出院时的神经功能预后方面异质性较大(组内I 2≥50%,P<0.05),而在改善长期神经功能预后方面亚组间的异质性较小(组内I 2<50%,P≥0.05)。结论ECPR可以改善CA患者出院或1个月内短期以及3个月以上长期神经功能预后,效果优于CCPR。但ECPR对CA患者出院前神经功能预后的影响尚不明确,仍需制定严格的纳入标准,进行更多高质量的随机对照试验予以证实。

Objective To investigate the effect of cardiopulmonary resuscitation(CPR)assisted by extracorporeal membrane oxygenation(ECMO)on the prognosis of neurological function in the patients with cardiac arrest(CA)by systematic review.Methods PubMed,Web of Science,Ovid,Cochrane Library,China Knowledge Network,Wanfang Database,Chinese Medical Journal Full Text Database,and Chinese Biomedical Literature Database were searched from the inception to February 2023.Literature screening,quality evaluation and data extraction were performed according to the literature inclusion and exclusion criteria,and RevMan 5.3 software was used for statistical analysis.Results A total of 2694 patients were included in 9 studies,including 717 patients in the extracorporeal cardiopulmonary resuscitation(ECPR)group and 1977 patients in the conventional cardiopulmonary resuscitation(CCPR)group.Meta analysis results showed that compared with CCPR,ECPR can improve short-term(discharge or within 1 month)neurological function prognosis[OR=2.93,95%CI(1.76,4.87),P<0.0001]and long-term neurological function prognosis[OR=0.12,95%CI(0.07,0.17),P<0.00001]in CA patients.Subgroup analysis showed that the implementation of ECPR in the patients with in-hospital cardiac arrest(IHCA)and out-of-hospital cardiac arrest(OHCA)had greater heterogeneity in improving neurological outcomes at discharge(I 2≥50%within the groups,P<0.05),but little heterogeneity between subgroups in improving long-term neurological outcomes(I 2<50%within the groups,P≥0.05).Conclusions ECPR can improve the short-term(discharge or within 1 month)and long-term(more than 3 months)neurological function prognosis of CA patients,and the effect is better than CCPR.However,the effect of ECPR on the neurological function prognosis of CA patients before discharge is still unclear,and strict inclusion criteria need to be established and more high-quality randomized controlled trials are used to verify.