Acute cardiac care & resuscitation
Impact of Cardiac Rhythm Dynamics during Cardiopulmonary Resuscitation on Clinical Outcomes in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation (ECPR): A Systematic Review and Meta-analysis
Authors' conclusion
Rhythm dynamics provide valuable prognostic insights for candidates for extracorporeal cardiopulmonary resuscitation. Rhythm decay toward asystole may predict resuscitation failure and poor neurological survival, suggesting that it should prompt a critical re-evaluation of the appropriateness of extracorporeal cardiopulmonary resuscitation.
Study context
- Population
- Subjects with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation
- Participants
- 5,183 subjects10 observational studies
- Comparison
- Rhythm improvement vs refractory non-shockable rhythms; rhythm decay vs sustained shockable rhythm
- Outcome
- Survival with a favorable neurological outcome
- Follow-up
- Longest
Methodological detailsrandom-effects model analysis with the Hartung-Knapp adjustment, Ten observational studies
- Random-effects model analysis with the Hartung-Knapp adjustment
- Ten observational studies
Pooled result
As reported in the abstract
Relative risk (95% CI)
Rhythm Improvementvs refractory non-shockable rhythmsGRADE: Low
3.12(1.26–7.74)
Rhythm Decayvs sustained shockable rhythmGRADE: Moderate
0.41(0.21–0.80)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Good neurological recovery, by type of rhythm decay (subgroup)Rhythm Decayvs sustained shockable rhythmDecay toward asystole; GRADE: Moderate | 0.20 (0.09–0.45) | |
| Good neurological recovery, by type of rhythm decay (subgroup)Rhythm Decayvs sustained shockable rhythm | 0.62 (0.31–1.25) | |
| 0.050.21520Relative risk (log scale) |
- Good neurological recovery, by type of rhythm decay (subgroup): decay toward pulseless electrical activity; did not reach statistical significance; GRADE: Low
Original publication
Impact of Cardiac Rhythm Dynamics during Cardiopulmonary Resuscitation on Clinical Outcomes in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation (ECPR): A Systematic Review and Meta-analysis. Resuscitation. Published 6 October 2026. doi:10.
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