scholarly journals Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Maziar Khorsandi ◽  
Scott Dougherty ◽  
Omar Bouamra ◽  
Vasudev Pai ◽  
Philip Curry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiogenic Shock ◽  
Meta Analysis ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Adult Cardiac Surgery

scholarly journals Extra-Corporeal Membrane Oxygenation (ECMO) for Postcardiotomy Cardiogenic Shock (PCCS) in Asian Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Di-huan Li ◽  
Ming-wei Sun ◽  
Ting Li ◽  
Ting Yuan ◽  
Ping Zhou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Failure ◽  
Survival Rate ◽  
Cardiogenic Shock ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Adult Patients ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Postcardiotomy Cardiogenic Shock

Abstract Background Extra-corporeal membrane oxygenation (ECMO) is an important extracorporeal life support system to treat patients with postcardiotomy cardiogenic shock (PCCS). But its effectiveness and safety are still inconclusive. Existing systematic reviews and meta-analysis have heterogeneity challenges such as the inclusion of different races in the same study.Objective The impact of ECMO treatment on the survival rate of Asian adult patients with PCCS was evaluated by searching the literature and using the method of systematic review and meta-analysis.Study Design and Methods PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, WANFANG MED ONLINE, SinoMed were searched to find relevant research on the use of ECMO on PCCS patients in Asia. Outcomes included survival rate to hospital discharge, long-term survival rate, complications.Results A total of 32 articles were selected, including observational studies and one RCT, involving China and Japan covering 4,278 PCCS patients. The pooled rate of survival to hospital discharge was 43.0% (95% CI 38% ~47%, I2 = 87%), the pooled 1-year, 2-year, and 3-year survival rate were 34% (95% CI 26% ~ 42%, I2 = 85%), 29% (95% CI 18% ~39%, I2 = 93%), 25% (95%CI 16% ~35%, I2=93%). The pooled rate of bleeding, neurologic complications, rethoracotomy, leg ischemia, renal failure, renal replacement therapy, and infection were 18% (95% CI 13% ~24%, I2=91%), 13% (95% CI 9% ~17%, I2 = 90.0%), 36% (95% CI 27% ~46%, I2 = 97.0%), 11% (95% CI 9% ~13%, I2 = 55%), 40% (95% CI 27% ~54%, I2 = 90%), 45% (95% CI 35% ~ 56%, I2 = 98%), 26% (95%CI (20%~31%, I2=95%).Conclusion ECMO can provide survival benefits for Asian adult patients with PCCS. However, attention should be paid to reducing the incidence of complications, especially renal failure. More high-quality clinical studies are needed to confirm the survival benefit of ECMO.

Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies

Transfusion ◽  
2016 ◽  
Vol 56 (8) ◽  
pp. 2146-2153 ◽  
Author(s):  
Francesco Vasques ◽  
Eeva-Maija Kinnunen ◽  
Marek Pol ◽  
Giovanni Mariscalco ◽  
Francesco Onorati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Adult Cardiac Surgery

scholarly journals Do continuous forms of intra-operative ultrafiltration enhance recovery after adult cardiac surgery with cardiopulmonary bypass? A protocol for systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Joel Bierer ◽  
David Horne ◽  
Roger Stanzel ◽  
Mark Henderson ◽  
Leah Boulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inflammatory Syndrome ◽  
Adult Cardiac Surgery

Abstract Background Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory syndrome that adversely impacts cardiopulmonary function and can contribute to prolonged postoperative recovery. Intra-operative ultrafiltration during CPB is a strategy developed by pediatric cardiac specialists, aiming to dampen the inflammatory syndrome by removing circulating cytokines and improving coagulation profiles during the cardiac operation. Although ultrafiltration is commonly used in the pediatric population, it is not routinely used in the adult population. This study aims to evaluate if randomized evidence supports the use of continuous intra-operative ultrafiltration to enhance recovery for adults undergoing cardiac surgery with CPB. Methods This systematic review and meta-analysis will include randomized controlled trials (RCT) that feature continuous forms of ultrafiltration during adult cardiac surgery with CPB, specifically assessing for benefit in mortality rates, invasive ventilation time and intensive care unit length of stay (ICU LOS). Relevant RCTs will be retrieved from databases, including MEDLINE, Embase, CENTRAL and Scopus, by a pre-defined search strategy. Search results will be screened for inclusion and exclusion criteria by two independent persons with consensus. Selected RCTs will have study demographics and outcome data extracted by two independent persons and transferred into RevMan. Risk of bias will be independently assessed by the Revised Cochrane Risk-of-Bias (RoB2) tool and studies rated as low-, some-, or high- risk of bias. Meta-analyses will compare the intervention of continuous ultrafiltration against comparators in terms of mortality, ventilation time, ICU LOS, and renal failure. Heterogeneity will be measured by the χ2 test and described by the I2 statistic. A sensitivity analysis will be completed by excluding included studies judged to have a high risk of bias. Summary of findings and certainty of the evidence, determined by the GRADE approach, will display the analysis findings. Discussion The findings of this systematic review and meta-analysis will summarize the evidence to date of continuous forms of ultrafiltration in adult cardiac surgery with CPB, to both inform adult cardiac specialists about this technique and identify critical questions for future research in this subject area. Systematic review registration This systematic review and meta-analysis is registered in PROSPERO CRD42020219309 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219309). 

scholarly journals Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (4) ◽  
pp. 1039 ◽  
Author(s):  
Mariusz Kowalewski ◽  
Pietro Giorgio Malvindi ◽  
Kamil Zieliński ◽  
Gennaro Martucci ◽  
Artur Słomka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Critically Ill Adults ◽  
Meta Analyses

During veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement included adult patients from studies published between January 2000 and March 2019. The search was conducted through numerous databases. Overall, from 62 papers, 7581 patients were included, among whom 3337 (44.0%) received LV unloading concomitant to VA-ECMO. Overall, in-hospital mortality was 58.9% (4466/7581). A concomitant strategy of LV unloading as compared to ECMO alone was associated with 12% lower mortality risk (RR 0.88; 95% CI 0.82–0.93; p < 0.0001; I2 = 40%) and 35% higher probability of weaning from ECMO (RR 1.35; 95% CI 1.21–1.51; p < 0.00001; I2 = 38%). In an analysis stratified by setting, the highest mortality risk benefit was observed in case of acute myocardial infarction: RR 0.75; 95%CI 0.68–0.83; p < 0.0001; I2 = 0%. There were no apparent differences between two techniques in terms of complications. In heterogeneous populations of critically ill adults in CS and supported with VA-ECMO, the adjunct of LV unloading is associated with lower early mortality and higher rate of weaning.

Venoarterial extracorporeal membrane oxygenation with intra-aortic balloon pump for postcardiotomy cardiogenic shock: A systematic review and meta-analysis

Perfusion ◽  
2021 ◽  
pp. 026765912110425
Author(s):  
Daochao Huang ◽  
Anyi Xu ◽  
QiongChan Guan ◽  
Jie Qin ◽  
Chuang Zhang
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo ◽  
Postcardiotomy Cardiogenic Shock

Objective: Intra-aortic balloon pump (IABP) is currently recommended as a strategy to address the increased afterload in patients who received venoarterial extracorporeal membrane oxygenation (VA-ECMO). The benefit of VA-ECMO with IABP in postcardiotomy cardiogenic shock is inconclusive. A systematic review and meta-analysis was conducted to assess the influence of VA-ECMO with IABP for postcardiotomy cardiogenic shock (PCS). Methods: The Cochrane Library, PubMed, and Embase were searched for all articles published from 1 January, 1964 to July 11, 2020. Retrospective cohort studies targeting the comparison of VA-ECMO with IABP and isolated VA-ECMO were included in this study. Results: We included 2251 patients in the present study (917 patients in the VA-ECMO with IABP group and 1334 patients in the isolated VA-ECMO group). Deaths occurred in 589 of 917 patients (64.2%) in the VA-ECMO with IABP group and occurred in 885 of 1334 patients (66.3%) in isolated VA-ECMO group. Pooling the results of all studies showed that VA-ECMO with IABP was not related to a reduced in-hospital mortality in patients who received VA-ECMO for PCS (RR, 0.95; 95% CI, 0.86–1.04; p = 0.231). In addition, VA-ECMO with IABP was not related to an increased rate of VA-ECMO weaning in patients who received VA-ECMO for PCS (RR, 1.28; 95% CI, 0.99–1.66; p = 0.058). Conclusions: This study indicates that VA-ECMO with IABP did not improve either in-hospital survival or weaning for VA-ECMO in postcardiotomy cardiogenic shock patients.

Sign in / Sign up

Export Citation Format

Share Document