Methodology: 4/5
Usefulness: 2.5/5
Suverein MM, et al. N Engl J Med. 2023 Jan 26;388(4):299-309. doi: 10.1056/NEJMoa2204511.
Question and Methods: Does eCPR increase survival at 30 days with good neurologic outcome in refractory OHCA caused by an initial cardiac ventricular arrhythmia when compared to conventional CPR.
Findings: No difference was found in survival in a multicenter, pragmatic, randomized controlled trial of 160 adult patients conducted in the Netherlands (OR 1.4 (95% CI 0.5-3.5), P=0.52, RR 1.05 (95% CI 0.97-1.13) or in adverse events (eCPR n= 1.4 (±0.9) vs, conventional CPR n=1 (±0.6), P=>0.5).
Limitations: Small number of participants and lack of protocol for EMS and hospital staff. A substantial number of patients regained ROSC between randomization and arrival at hospital. Lack of information led to post-randomization exclusion. Impossible to mask providers to treatment group assignments.
Interpretation: The current available data do not yet support the use of eCPR in patients with OHCA.
JC Supervisor: Dr. Ian Stiell
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