Impact of prehospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest on survival with good neurological function: a systematic review and meta-analysis
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Bibliographic record
Abstract
Aim: Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) has been proposed to reduce delays in ECPR delivery in refractory out-of-hospital cardiac arrests (OHCA) and improve outcomes. Our aim was to synthesize the literature on outcomes of prehospital ECPR in OHCA, focusing on low-flow times (emergency call to extracorporeal blood flow) and survival with good neurological function, comparing them to in-hospital ECPR when possible. Methods: -analysis of studies reporting outcomes in adult OHCA patients treated with prehospital ECPR. Searches spanned seven databases and relevant grey literature (last updated January 21, 2025). Eligible studies included ≥ 5 patients. The primary outcome was survival with good neurological function (CPC 1-2). Pooled estimates were calculated using random-effects models. Meta-regression assessed the association between low-flow time and survival. Comparative analyses with in-hospital ECPR were performed when possible. Results: Eight cohort studies involving 305 patients (84% male, mean age 57) were included. Survival with good neurological function was 25% (95%CI: 17-35%). Mean low-flow time was 59 min (95%CI: 46-72). Meta-regression showed a significant inverse association between low-flow time and good neurological outcomes (β = -0.0271, 95%CI: -0.0536 to -0.0006; p = 0.045). Compared to in-hospital ECPR, prehospital ECPR showed no significant difference in survival (RR 1.23, 95%CI: 0.35-4.38) but was associated with significantly shorter low-flow times (mean difference -30 min, 95%CI: -44 to -16). Conclusion: Prehospital ECPR is associated with a 25% rate of survival with good neurological function. Shorter low-flow times were associated with improved outcomes.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.004 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it