Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis.

"Declarations Ethics approval and consent to participateNot applicable. Competing interestsRRL acknowledges research support from the Clinician Scientist Development Unit, Yong Loo Lin School of Medicine, National University of Singapore. KR serves on the steering committee of the Extracorporeal Life Support Organisation. He is the current chair of the Publications Committee and is the past co-chair of the Scientific Oversight Committee. YO has received a research grant from the ZOLL Foundation and an overseas scholarship from the FUKUDA Foundation for Medical Technology and the International Medical Research Foundation. MEHO reports grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation programme to their Community CPR Training Centre Research Program in Norway. MEHO is a Scientific Advisor to TIIM Healthcare SG and Global Healthcare SG. These organisations have no role in conducting this research. Competing interests RRL acknowledges research support from the Clinician Scientist Development Unit, Yong Loo Lin School of Medicine, National University of Singapore. KR serves on the steering committee of the Extracorporeal Life Support Organisation. He is the current chair of the Publications Committee and is the past co-chair of the Scientific Oversight Committee. YO has received a research grant from the ZOLL Foundation and an overseas scholarship from the FUKUDA Foundation for Medical Technology and the International Medical Research Foundation. MEHO reports grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation programme to their Community CPR Training Centre Research Program in Norway. MEHO is a Scientific Advisor to TIIM Healthcare SG and Global Healthcare SG. These organisations have no role in conducting this research."

"Funding This study was supported by a scientific research grant from the JSPS KAKENHI (JP23K16253 to YO) and the ZOLL Foundation (YO)."

"The original protocol was registered with PROSPERO (CRD42022332623). We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement (Additional file : PRISMA Checklist) [], and the prespecified methodology and analytical plan from our original meta-analysis. Briefly, we updated our literature search and screened the literature through 1 November 2023. We followed the prior inclusion criteria of either RCTs or propensity score matched studies comparing ECPR against conventional cardiopulmonary resuscitation (CCPR) in cardiac arrest. We did a random-effects meta-analyses (Mantel–Haenszel method) of binary outcomes using the DerSimonian–Laird model [, ] and present outcomes as pooled odds ratios (OR) with 95% confidence intervals (CIs). We adhered to the Grading of Recommendations, Assessment, Development, and Evaluations approach when assessing the certainty of evidence []. We assessed risk of bias via the Cochrane Risk of Bias 2 Tool for RCTs and Newcastle Ottawa Score for PSMs."