Evidence map›Paper›PMID 40435032›Full record

SynthesisCritical care science2025

Feasibility of implementing extracorporeal cardiopulmonary resuscitation in a middle-income country: systematic review and cardiac arrest case series.

Gabriel Afonso Dutra Kreling, Pedro Vitale Mendes, Luis Carlos Maia Cardozo Junior, Karina Turaça Kasahaya, Marcelo Park, Ludhmila Abrahão Hajjar, Ian Ward A Maia

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Critical care science, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Gabriel Afonso Dutra KrelingIntensive Care Unit, Emergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0000-0003-1212-3166
Pedro Vitale MendesIntensive Care Unit, Emergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0000-0002-6062-9105
Luis Carlos Maia Cardozo JuniorIntensive Care Unit, Emergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0000-0002-0459-6564
Karina Turaça KasahayaEmergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0009-0002-6246-2094
Marcelo ParkIntensive Care Unit, Emergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0000-0002-4201-2718
Ludhmila Abrahão HajjarIntensive Care Unit, Emergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0000-0001-5645-2055
Ian Ward A MaiaEmergency Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.ORCID http://orcid.org/0000-0002-6125-7913

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest and assess the plausibility of implementing an extracorporeal cardiopulmonary resuscitation program in a public health care system hospital in a middle-income country.

methodsA systematic review, meta-analysis, meta-regression analysis, and trial sequence analysis were performed to assess the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest. Additionally, a local cardiac arrest registry was analyzed to identify potential patients eligible for extracorporeal cardiopulmonary resuscitation.

resultsThe systematic review included 31 studies. The main and sensitivity analyses consistently demonstrated that extracorporeal cardiopulmonary resuscitation was associated with favorable neurological outcomes (cerebral performance category 1 or 2, RR 1.45, 95%CI 1.19 - 1.77) and survival (RR 1.29, 95%CI 1.10 - 1.52). Age was inversely related to neurological outcome and survival. Our cardiac arrest registry included 55 patients with a median age of 54 years and a survival rate of 18.2% (10/55). Survivors had an initial shockable rhythm. In the most inclusive scenario, 13 patients would have been eligible for extracorporeal cardiopulmonary resuscitation. Under stricter criteria (age ≤ 65 years, low-flow time ≤ 30 min, and number of defibrillations ≥ 3), 4 patients would have been eligible.

conclusionExtracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest is associated with improved neurological outcomes and survival. The use of an extracorporeal cardiopulmonary resuscitation program in our hospital is plausible. Using conservative eligibility criteria, we estimate that at least four patients would be eligible for extracorporeal cardiopulmonary resuscitation within six months of the program initiation.

Indexed as

Cardiopulmonary ResuscitationExtracorporeal Membrane OxygenationHeart ArrestDeveloping CountriesFeasibility StudiesFemaleHumansMaleMiddle Aged

Identifiers

PMID40435032
PMCPMC12094697

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.