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This month’s update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Extracorporeal life support for out-of-hospital cardiac arrest: a nationwide multicentre study by Jeong et al
Topic: out-of-hospital cardiac arrest
Rating: worth a peek
This paper sought to determine the benefit of extracorporeal life support (ECLS) in out-of-hospital cardiac arrest.1 The authors conducted a retrospective observational study using South Korean national registry data. As such, the methodology was primarily hypothesis generating. The authors chose a patient-orientated primary neurological outcome of restricted mean survival time (RMST), a proxy for life expectancy and restrictive mean time lost (RMTL), equivalent to an HR. They analysed data for 12 006 patients of whom 272 received ECLS.
Patients receiving ECLS were typically younger, male, witnessed, public arrests for whom there was a finding of better neurological 30-day survival (RMST difference 5.5 days, 95% CI 4.1 to 7.0 days) RMTL ratio 0.79, 95% CI 0.74 to 0.84; p<0.001). However, there was no statistical difference between ECLS and the conventional C reactive protein (CPR) group after propensity matching.
Subgroup analysis suggested that ECLS improved neurological survival in patients with non-shockable rhythms or CRP time >20 min. These findings remained after propensity matching. However, subgroup analyses are at risk of a range of biases.
Few other countries have sufficient provision of ECLS to build on the findings of this study. In the UK, extracorporeal membrane oxygenation is geographically limited and centralised and ECLS has received limited piloting.
ECLS may benefit select …
Twitter @clifford0584, @hirstposition
Contributors TAGS coordinated, drafted and edited the manuscript with equal contributions to the summaries and final manuscript by LC, DD, RH, MN, GO and GP.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.