{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:42:45Z","timestamp":1771893765493,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Extracorporeal membrane oxygenation with CPR (eCPR) or therapeutic hypothermia (TH) seems to be a very effective CPR strategy to save patients with cardiac arrest (CA). Furthermore, the subsequent post-CA neurologic outcomes have become the focus. Therefore, there is an urgent need to find a way to improve survival and neurologic outcomes for CA.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> We conducted this meta-analysis to find a more suitable CPR strategy for patients with CA.<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> We searched four online databases (PubMed, Embase, CENTRAL, and Web of Science). From an initial 1,436 articles, 23 studies were eligible into this meta-analysis, including a total of 2,035 patients.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> eCPR combined with TH significantly improved the short-term (at discharge or 28 days) survival [OR = 2.27, 95% CIs (1.60\u20133.23), <jats:italic>p<\/jats:italic> &amp;lt; 0.00001] and neurologic outcomes [OR = 2.60, 95% CIs (1.92\u20133.52), <jats:italic>p<\/jats:italic> &amp;lt; 0.00001). At 3 months of follow-up, the results of survival [OR = 3.36, 95% CIs (1.65\u20136.85), <jats:italic>p<\/jats:italic> &amp;lt; 0.0008] and favorable neurologic outcomes [OR = 3.02, 95% CIs (1.38\u20136.63), <jats:italic>p<\/jats:italic> &amp;lt; 0.006] were the same as above. Furthermore, there was no difference in any bleeding needed intervention [OR = 1.33, 95% CIs (0.09\u20131.96), <jats:italic>p<\/jats:italic> = 0.16] between two groups.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> From this meta-analysis, we found that eCPR combined with TH might be a more suitable CPR strategy for patients with CA in improving survival and neurologic outcomes, and eCPR with TH did not increase the risk of bleeding. Furthermore, single-arm meta-analyses showed a plausible way of temperature and occasion of TH.<\/jats:p>","DOI":"10.3389\/fcvm.2021.703567","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T09:19:28Z","timestamp":1628846368000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["eCPR Combined With Therapeutic Hypothermia Could Improve Survival and Neurologic Outcomes for Patients With Cardiac Arrest: A Meta-Analysis"],"prefix":"10.3389","volume":"8","author":[{"given":"Jingwei","family":"Duan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingbian","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changju","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanchao","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baomin","family":"Duan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S337","DOI":"10.1161\/CIR.0000000000000918","article-title":"Part 1: executive summary: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"142","author":"Merchant","year":"2020","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1097\/ALN.0000000000002700","article-title":"Postresuscitation care after out-of-hospital cardiac arrest: clinical update and focus on targeted temperature management","volume":"131","author":"Kirkegaard","year":"2019","journal-title":"Anesthesiology."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1161\/CIRCULATIONAHA.115.018788","article-title":"Duration of prehospital resuscitation efforts after out-of-hospital cardiac arrest","volume":"133","author":"Nagao","year":"2016","journal-title":"Circulation."},{"key":"B4","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1001\/jama.197.8.615","article-title":"The role of assisted circulation in cardiac resuscitation","volume":"197","author":"Kennedy","year":"1966","journal-title":"JAMA."},{"key":"B5","doi-asserted-by":"publisher","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Part 3: adult basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"142","author":"Panchal","year":"2020","journal-title":"Circulation."},{"key":"B6","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/S0140-6736(08)60958-7","article-title":"Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis","volume":"372","author":"Chen","year":"2008","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1056\/NEJMoa012689","article-title":"Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest","volume":"346","year":"2002","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.resuscitation.2014.09.010","article-title":"Refractory cardiac arrest treated with mechanical cpr, hypothermia, ecmo and early reperfusion (the cheer trial)","volume":"86","author":"Stub","year":"2015","journal-title":"Resuscitation."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1097\/01.CCM.0000261892.10559.85","article-title":"Prediction of short-term and long-term outcomes after cardiac arrest: A prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations","volume":"35","author":"Prohl","year":"2007","journal-title":"Critical Care Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1002\/mnfr.201300325","article-title":"Epigallocatechin-3-gallate, a dyrk1a inhibitor, rescues cognitive deficits in down syndrome mouse models and in humans","volume":"58","author":"De","year":"2014","journal-title":"Mol Nutr Food Res."},{"key":"B11","first-page":"889","article-title":"Implement meta-analysis with non-comparative binary data in revman software","volume":"14","author":"Chen","year":"2014","journal-title":"Chin J Evid Based Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"132","DOI":"10.15441\/ceem.16.145","article-title":"Extracorporeal cardiopulmonary resuscitation among patients with out-of-hospital cardiac arrest","volume":"3","author":"Choi","year":"2016","journal-title":"Clin Exp Emerg Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.ijcard.2016.12.003","article-title":"Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience","volume":"231","author":"Dennis","year":"2017","journal-title":"Int J Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1111\/aas.12843","article-title":"Extracorporeal cardiopulmonary resuscitation after out-of-hospital cardiac arrest in a Danish health region","volume":"61","author":"Fj\u00f8lner","year":"2017","journal-title":"Acta Anaesthesiol Scand"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e019811","DOI":"10.1136\/bmjopen-2017-019811","article-title":"Impact of extracorporeal cardiopulmonary resuscitation on outcomes of elderly patients who had out-of-hospital cardiac arrests: A single-centre retrospective analysis","volume":"8","author":"Goto","year":"2018","journal-title":"BMJ Open"},{"key":"B16","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/clc.23169","article-title":"Experience of extracorporeal cardiopulmonary resuscitation in a refractory cardiac arrest patient at the emergency department","volume":"42","author":"Han","year":"2019","journal-title":"Clin Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.resuscitation.2017.08.217","article-title":"Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest","volume":"120","author":"Jouffroy","year":"2017","journal-title":"Resuscitation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1016\/j.resuscitation.2010.03.037","article-title":"Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support","volume":"81","author":"Kagawa","year":"2010","journal-title":"Resuscitation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.1161\/CIRCULATIONAHA.111.067538","article-title":"Should we emergently revascularize occluded coronaries for cardiac arrest? Rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention","volume":"126","author":"Kagawa","year":"2012","journal-title":"Circulation."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e002123","DOI":"10.1161\/JAHA.115.002123","article-title":"Do Lower target temperatures or prolonged cooling provide improved outcomes for comatose survivors of cardiac arrest treated with hypothermia?","volume":"4","author":"Kagawa","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"B21","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1186\/s13054-014-0535-8","article-title":"An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: A propensity-matched study","volume":"18","author":"Kim","year":"2014","journal-title":"Crit Care"},{"key":"B22","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1177\/0885066618801269","article-title":"Target temperature management may not improve clinical outcomes of extracorporeal cardiopulmonary resuscitation","volume":"34","author":"Kim","year":"2019","journal-title":"J Intensive Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13049-016-0266-8","article-title":"Out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal membrane oxygenation: focus on survival rate and neurologic outcome","volume":"24","author":"Lee","year":"2016","journal-title":"Scand J Trauma Resusc Emerg Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1097\/CCM.0b013e31827ca4c8","article-title":"Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: A propensity-matched study and predictor analysis","volume":"41","author":"Maekawa","year":"2013","journal-title":"Crit Care Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.jcrc.2020.11.008","article-title":"Impact of therapeutic hypothermia on bleeding events in adult patients treated with extracorporeal life support peri-cardiac arrest","volume":"62","author":"Mecklenburg","year":"2020","journal-title":"J Crit Care."},{"key":"B26","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1253\/circj.CJ-09-0502","article-title":"Early induction of hypothermia during cardiac arrest improves neurological outcomes in patients with out-of-hospital cardiac arrest who undergo emergency cardiopulmonary bypass and percutaneous coronary intervention","volume":"74","author":"Nagao","year":"2010","journal-title":"Circul J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jcrc.2018.08.006","article-title":"Low-flow time is associated with a favorable neurological outcome in out-ofhospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation","volume":"48","author":"Otani","year":"2018","journal-title":"J Crit Care"},{"key":"B28","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13019-016-0437-8","article-title":"Therapeutic hypothermia in adult patients receiving extracorporeal life support: early results of a randomized controlled study","volume":"11","author":"Pang","year":"2016","journal-title":"J Cardiothorac Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/j.hlc.2016.11.022","article-title":"Therapeutic hypothermia may improve neurological outcomes in extracorporeal life support for adult cardiac arrest","volume":"26","author":"Pang","year":"2017","journal-title":"Heart Lung Circ"},{"key":"B30","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/j.athoracsur.2019.03.033","article-title":"Neurologic outcomes in patients who undergo extracorporeal cardiopulmonary resuscitation","volume":"108","author":"Ryu","year":"2019","journal-title":"Ann Thorac Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1016\/j.resuscitation.2014.01.031","article-title":"Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study","volume":"85","author":"Sakamoto","year":"2014","journal-title":"Resuscitation"},{"key":"B32","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1136\/emermed-2015-205232","article-title":"Emergency extracorporeal life support and ongoing resuscitation: A retrospective comparison for refractory out-of-hospital cardiac arrest","volume":"34","author":"Schober","year":"2017","journal-title":"Emerg Med J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s13049-017-0440-7","article-title":"Neurological outcomes and duration from cardiac arrest to the initiation of extracorporeal membrane oxygenation in patients with out-of-hospital cardiac arrest: A retrospective study","volume":"25","author":"Yukawa","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1016\/j.jacc.2015.10.005","article-title":"2015 ACC\/AHA\/SCAI focused update on primary percutaneous coronary intervention for patients with st-elevation myocardial infarction: an update of the 2011 ACCF\/AHA\/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction","volume":"67","author":"Levine","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1016\/j.athoracsur.2008.12.079","article-title":"Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in adults","volume":"87","author":"Thiagarajan","year":"2009","journal-title":"Ann Thorac Surg."},{"key":"B36","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1097\/MAT.0b013e3181bad907","article-title":"Use of extracorporeal membrane oxygenation for adults in cardiac arrest (e-cpr): A meta-analysis of observational studies","volume":"55","author":"Cardarelli","year":"2009","journal-title":"ASAIO J."},{"key":"B37","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1378\/chest.106.3.872","article-title":"Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. A prospective study","volume":"106","author":"Berger","year":"1994","journal-title":"Chest."},{"key":"B38","doi-asserted-by":"publisher","first-page":"161","DOI":"10.15240\/tul\/001\/2019-2-011","article-title":"Cost-effectiveness of extracorporeal membrane oxygenation in resuscitation of patients with refractory cardiac arrest","volume":"22","author":"Buriskova","year":"2019","journal-title":"Ekonomie Manage."},{"key":"B39","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.resuscitation.2015.06.021","article-title":"Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest","volume":"96","author":"Kjaergaard","year":"2015","journal-title":"Resuscitation."},{"key":"B40","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1001\/jama.295.1.50","article-title":"First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults","volume":"295","author":"Nadkarni","year":"2006","journal-title":"JAMA."},{"key":"B41","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jcrc.2017.02.014","article-title":"Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis","volume":"39","author":"Sy","year":"2017","journal-title":"J Crit Care."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1097\/ALN.0000000000000086","article-title":"Cardiac resuscitation and coagulation","volume":"120","author":"Weidman","year":"2014","journal-title":"Anesthesiology."},{"key":"B43","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1097\/SHK.0000000000001611","article-title":"Short-term efficacy and safety of different mechanical hemodynamic support devices for cardiogenic shock or high-risk pci: A network meta-analysis of thirty-seven trials","volume":"55","author":"Duan","year":"2021","journal-title":"Shock."},{"key":"B44","doi-asserted-by":"publisher","first-page":"2256","DOI":"10.1001\/jama.2020.3508","article-title":"When should clinicians act on non-statistically significant results from clinical trials?","volume":"323","author":"Young","year":"2020","journal-title":"JAMA."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.703567\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T09:19:30Z","timestamp":1628846370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.703567\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,13]]},"references-count":44,"alternative-id":["10.3389\/fcvm.2021.703567"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.703567","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,13]]},"article-number":"703567"}}