20, 23, 30
Source of the pooled operating characteristics for signs of life in Chapter 20 §20.5.4 — a STRONG rule-out (NPV 0.96) and a WEAK rule-in (PPV 0.22), which is the correct way to use them. Also the source of the TiPS65 figures used in §20.7 to illustrate why 'accuracy' is the wrong headline metric in a low-event-rate population: 88% accurate with 17% sensitivity.
Within-cohort
DOI 10.1186/s13643-025-02818-y. PROSPERO CRD42024530305
Pre- and peri-cannulation predictors of neurological outcome
Heterogeneous cohorts, several predictors supported by only one study each, all constituent studies observational and confined to ECPR recipients. Abstract only.
FAVOURABLE outcome associated with: age under 65 (OR 6.17); shockable rhythm at ECMO initiation (OR 6.67) or on hospital arrival (OR 3.68); initial pH 7.0 or above (OR 2.01); ANY LIFE SIGN (OR 9.63; sensitivity 0.89, specificity 0.46, PPV 0.22, NPV 0.96); transient ROSC; public location; hypothermic aetiology — though several of these rest on a single study. UNFAVOURABLE outcome associated with hypoxic brain injury on CT (OR 12.40; sensitivity 0.366, specificity 0.955, PPV 0.767, NPV 0.787) and elevated serum creatinine (OR 2.22). TiPS65 at a cut-off of 4 points: accuracy 88.4% and 88.6% in two studies, but SENSITIVITY 0.172 and 0.193, specificity 0.971 and 0.985, PPV 0.423 and 0.646, NPV 0.906 and 0.896. Call-to-hospital time and bystander CPR had mixed results.
10 studies identified; 8 comprising 4,353 patients permitted collective statistical analysis. Adults undergoing ECPR for cardiac arrest.