Extracorporeal cardiopulmonary resuscitation for pediatric in-hospital cardiac arrest in single ventricle patients: a systematic review and meta-analysis
Bibliographic record
Abstract
Objectives: Assess the use of extracorporeal cardiopulmonary resuscitation (ECPR), compared with manual/mechanical cardiopulmonary resuscitation (CPR), for in-hospital cardiac arrest (IHCA) in pediatric patients with single ventricle (SV) congenital heart disease (CHD). Methods: PRISMA guidelines were followed with PROSPERO registration (CRD42023479671). We searched Medline, Embase, Web of Science, PubMed, and the Cochrane Library for studies published before January 23, 2025. The population included pediatric patients (<18 years old) with IHCA. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the ROBINS-I tool. Certainty of evidence was evaluated using the GRADE framework. Outcomes included short-term and long-term survival and favorable neurological outcome. Results: We identified 20 studies: 15 described ECPR in SV patients without a comparator group, and 5 compared SV ECPR patients vs. SV extracorporeal membrane oxygenation (ECMO) without ECPR (ECMO non-ECPR). Pooled synthesis for survival to hospital discharge was analyzed in 3 observational studies with 91 SV patients (pooled OR 0.66, 95% CI 0.37-1.01) and separately in 2 registry studies with 968 SV patients (OR 0.76, 95% CI 0.35-1.37 and OR 1.06, 95% CI 0.78-1.41) with very low certainty of evidence (downgraded for risk of bias and imprecision). These studies found no significant difference in survival to hospital discharge in ECPR compared to ECMO non-ECPR in pediatric SV patients. No studies were identified that compared pediatric SV patients who received ECPR vs. conventional/manual CPR. Conclusions: There is no direct evidence to either support or refute the use of ECPR during IHCA in pediatric patients with SV CHD, and there is inconclusive evidence to either support or refute the use of ECPR compared to ECMO non-ECPR. Additional research is needed to address the use of ECPR in this specific cardiac population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.038 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".