Low vs standardized dose anticoagulation regimens for extracorporeal membrane oxygenation: A meta-analysis

Background To compare the safety and efficacy of low-dose anticoagulation (LA) with that of standardized dose anticoagulation (SA) for patients supported with extracorporeal membrane oxygenation (ECMO). Methods PubMed, MEDLINE, the Cochrane Library, and Web of Science were screened for original articles. Screening was performed using predefined search terms to identify cohort studies reporting the comparison of LA with SA in patients supported with ECMO from Nov 1990 to Jun 2020. The effect size was determined by the odds ratio (OR) with the 95% confidence interval (CI). Results An analysis of 7 studies including a total of 553 patients was performed. LA (Low-heparin group) was administered to 255 patients, whereas the other 298 patients received SA (Full-heparin group). The incidence of gastrointestinal tract hemorrhage (OR 0.36, 95% CI 0.20–0.64) and surgical site hemorrhage (OR 0.43, 95% CI 0.20–0.94) were significantly lower in patients who underwent LA compared with that in those who underwent SA. The rates of hospital mortality (OR 0.81, 95% CI 0.42–1.56), successfully weaning off of ECMO (OR 0.80, 95% CI 0.30–2.14), pulmonary embolism (OR 0.79, 95% CI 0.24–2.65), intracardiac thrombus (OR 0.34, 95% CI 0.09–1.30), intracranial hemorrhage (OR 0.62, 95% CI 0.22–1.74), and pulmonary hemorrhage (OR 0.77, 95% CI 0.30–1.93) were similar between the two groups. Conclusions This meta-analysis confirms that LA is a feasible and safe anticoagulation strategy in patients supported by ECMO. Future studies should focus on the long-term benefits of LA compared with SA.

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The Efficiency and Safety of Bivalirudin versus Heparin in The Anticoagulation Therapy in Extracorporeal Membrane Oxygenation: A Meta-Analysis

10.21203/rs.3.rs-179603/v1 ◽

2021 ◽

Author(s):

Min Ma ◽

Shichu Liang ◽

Jingbo Zhu ◽

Yong He

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Major Bleeding ◽

Meta Analysis ◽

Anticoagulation Therapy ◽

Cost Effective ◽

Cochrane Library ◽

Thrombin Inhibitor ◽

Membrane Oxygenation ◽

Meta Analyses ◽

The Cochrane Library

Abstract Background: Bivalirudin is a direct thrombin inhibitor (DTI), which can be the alternative of unfractionated heparin (UFH). The efficiency and safety of bivalirudin versus UFH in the anticoagulation therapy in Extracorporeal membrane oxygenation(ECMO) remains unclear. The purpose of the meta-analysis is to evaluate the efficiency and safety of bivalirudin versus UFH in the anticoagulation therapy in ECMO.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. A systematic literature search for original studies was performed in PubMed, EMBASE and The Cochrane Library to identify all relevant studies published prior to January 13,2021. Studies were reviewed according to eligibility and exclusion criteria. The meta-analysis was used to estimate the efficiency and safety of bivalirudin versus UFH in the anticoagulation therapy in extracorporeal membrane oxygenation. Results: 6 retrospective studies with 254 patients were eventually included for the quantitative analysis. The results showed that the incidence of major bleeding(I2=66%, P=0.16, OR=0.43, 95%CI:0.13-1.40), thrombosis(I2=0%, P=0.09<0.1, OR=0.56, 95%CI:0.29-1.09) and 30-day mortality(I2=0%, P=0.50, OR=0.90, 95%CI:0.42-1.53) was not statistically significant between the bivalirudin group and the UFH group.Conclusions:This study suggests that bivalirudin and UFH are associated with similar rates of major bleeding, thrombosis and 30-day mortality in adult and pediatric ECMO support, which is safe, practicable, dependable, and cost-effective in comparison with UFH. Bivalirudin is non-inferior to UFH in the anticoagulation therapy in ECMO.

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Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer: a systematic review and meta-analysis

Surgical Endoscopy ◽

10.1007/s00464-021-08615-7 ◽

2021 ◽

Author(s):

Jae Young Moon ◽

Min Ro Lee ◽

Gi Won Ha

Keyword(s):

Rectal Cancer ◽

Meta Analysis ◽

Disease Free Survival ◽

Distant Recurrence ◽

Oncologic Outcomes ◽

Cochrane Library ◽

Transanal Total Mesorectal Excision ◽

Random Effects Models ◽

The Cochrane Library

Abstract Background Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer. Methods PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence. Results We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39–1.09, I2 = 0%), 0.79 (95% CI 0.57–1.10, I2 = 0%), 1.14 (95% CI 0.44–2.91, I2 = 66%), and 0.75 (95% CI 0.40–1.41, I2 = 0%), respectively. Conclusion In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.

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Efficacy of left ventricular unloading strategies during venoarterial extracorporeal membrane oxygenation in patients with cardiogenic shock: a protocol for a systematic review and Bayesian network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-047046 ◽

2021 ◽

Vol 11 (10) ◽

pp. e047046

Author(s):

Pengbin Zhang ◽

Shilin Wei ◽

Kerong Zhai ◽

Jian Huang ◽

Xingdong Cheng ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Bayesian Network ◽

Meta Analysis ◽

Left Ventricular ◽

Cochrane Library ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Patient Consent ◽

Va Ecmo

IntroductionVenoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with refractory cardiogenic shock. A common side effect of this technic is the resultant increase in left ventricular (LV) afterload which could potentially aggravate myocardial ischaemia, delay ventricular recovery and increase the risk of pulmonary congestion. Several LV unloading strategies have been proposed and implemented to mitigate these complications. However, it is still indistinct that which one is the best choice for clinical application. This Bayesian network meta-analysis (NMA) aims to compare the efficacy of different LV unloading strategies during VA-ECMO.Methods and analysisPubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform will be explored from their inception to 31 December 2020. Random controlled trials and cohort studies that compared different LV unloading strategies during VA-ECMO will be included in this study. The primary outcome will be in-hospital mortality. The secondary outcomes will include neurological complications, haemolysis, bleeding, limb ischaemia, renal failure, gastrointestinal complications, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays. Pairwise and NMA will respectively be conducted using Stata (V.16, StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the cumulative probability will be used to rank the included LV unloading strategies. The risk of bias will be conducted using the Cochrane Collaboration’s tool or Newcastle-Ottawa Quality Assessment Scale according to their study design. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed. The Grading of Recommendations Assessment, Development and Evaluation will be conducted to explore the quality of evidence.Ethics and disseminationEither ethics approval or patient consent is not necessary, because this study will be based on literature. The results will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42020165093.

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Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

10.21203/rs.2.11328/v2 ◽

2019 ◽

Author(s):

Jing Xiong ◽

Li Zhang ◽

Lei Bao

Keyword(s):

Systematic Review ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Meta Analysis ◽

Cochrane Library ◽

Membrane Oxygenation ◽

Venovenous Ecmo ◽

Complications And Mortality ◽

Overall Mortality

Abstract Background: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO in the treatment of neonatal respiratory failure, we performed a systematic review and meta-analysis of all the related studies. Methods: PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results: Four observational studies were included, with a total of 347 newborns. The overall mortality at hospital charge was 12% (5% - 18%) with a heterogeneity of I2 = 73.8% (p = 0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8% -19.2%) and 6.1% (2.6% - 9.6%) respectively. The most common complications associated with venovenous ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion: The overall mortality at discharge of venovenous ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples and higher quality of randomized controlled trials (RCT) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.

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Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

10.21203/rs.2.11328/v3 ◽

2020 ◽

Author(s):

Jing Xiong ◽

Li Zhang ◽

Lei Bao

Keyword(s):

Systematic Review ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Meta Analysis ◽

Cochrane Library ◽

Membrane Oxygenation ◽

Complications And Mortality ◽

Vv Ecmo ◽

Overall Mortality

Abstract Background: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO (VV ECMO) in the treatment of neonatal respiratory failure, we performed a systematic review and meta-analysis of all the related studies. Methods: PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results: Four observational studies were included, with a total of 347 newborns. VV ECMO was used for neonates with refractory respiratory failure unresponsive to maximal medical therapy. Median ages of the newborns at cannulation were 43.2 hours, 23 hours, 19hours, and 71 hours in the included four studies, respectively. The overall mortality at hospital charge was 12% (5%-18%) with a heterogeneity of I 2 =73.8% (p=0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8%-19.2%) and 6.1% (2.6%-9.6%), respectively. The most common complications associated with VV ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion: The overall mortality at discharge of VV ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples, and higher quality of randomized controlled trials (RCTs) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.

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Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

10.21203/rs.2.11328/v1 ◽

2019 ◽

Author(s):

Jing Xiong ◽

Li Zhang ◽

Lei Bao

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Meta Analysis ◽

Cochrane Library ◽

Bleeding Events ◽

Membrane Oxygenation ◽

Venovenous Ecmo ◽

Complications And Mortality ◽

Overall Mortality

Abstract Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO in the treatment of neonatal respiratory failure. Methods PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results Four observational studies were included, with a total of 347 newborns. The overall mortality at hospital charge was 12% (5% - 18%) with a heterogeneity of I2 = 73.8% (p = 0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8% -19.2%) and 6.1% (2.6% - 9.6%) respectively. The most common complications associated with venovenous ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion The overall mortality at discharge of venovenous ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples, and higher quality of randomized controlled trials (RCT) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.

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Dental Bulk-Fill Resin Composites Polymerization Efficiency: A Systematic Review and Meta-Analysis

Journal of Composites Science ◽

10.3390/jcs5060149 ◽

2021 ◽

Vol 5 (6) ◽

pp. 149

Author(s):

Reem A. Ajaj ◽

Nada J. Farsi ◽

Lama Alzain ◽

Nour Nuwaylati ◽

Raneem Ghurab ◽

...

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Relevant Information ◽

Cochrane Library ◽

Random Effects Model ◽

Inclusion Criteria ◽

Medical Subject Headings ◽

Future Studies ◽

Comprehensive Search ◽

The Cochrane Library

Dental Bulk-Fill Composites (BFCs) and Bulk-Fill Flowables (BFFs) were introduced in the market to facilitate efficient bulk filling of cavities up to 5 mm. The aim of this study was to synthesize the literature investigating their polymerization efficiency. A comprehensive search of PubMed and the Cochrane Library from 2010 to January 2019 was performed using the medical subject headings. Screening of the titles, abstracts and full text was performed. Data extraction for relevant information was done on the included studies. Clinically relevant parameters were selected to present the study estimates (meta-analysis) using a random effects model for polymerization efficiency (Degree of Conversion (DC) and Depth of Cure (DoC)). Twenty one studies fulfilled the inclusion criteria and were included in the analysis reporting seven BFCs and nine BFFs. Ten materials reported acceptable DC values of above 55% and ten materials reported adequate DoC values. Most of the stated materials reported adequate DC and DoC values in at least one investigation with BFFs showing higher and more acceptable values compared to packable BFCs. It is suggested that future studies be carried out using a standard methodology following the ISO 4049 standard and manufacturer’s instructions to compare results.

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A meta-analysis of traditional and functional end-to-side anastomosis in radiocephalic fistula for dialysis access

International Urology and Nephrology ◽

10.1007/s11255-020-02691-9 ◽

2021 ◽

Author(s):

Tang Weigang ◽

Xu Wei ◽

Gong Lifeng ◽

Lu Jingkui ◽

Li Yani ◽

...

Keyword(s):

Success Rate ◽

Patency Rate ◽

Meta Analysis ◽

Cochrane Library ◽

Dialysis Access ◽

Maturation Time ◽

Surgical Success ◽

The Cochrane Library ◽

Easy Operation

Abstract Objective Functional vein end to arterial side (ETS) anastomosis uses vein side to arterial side (STS) anastomosis with distal vein ligation, which can achieve similar effects as those of ETS after STS anastomosis. The purpose of the study was to provide a meta-analysis to compare the clinical outcomes between traditional and functional ETS anastomosis in radiocephalic fistula for dialysis access. Methods Databases including PubMed, EMbase, the Cochrane Library, CNKI, Wanfang database were searched from the inception to February 6, 2020. Eligible studies comparing traditional and functional ETS anastomosis in radiocephalic fistula were included. Data were analyzed using Review Manager Version 5.3. Results Seven studies were included in the meta-analysis. Five randomized controlled trials and two cohort studies involving 841 patients were identified. Compared with traditional ETS anastomosis, functional ETS anastomosis had shorter anastomosis time (MD − 9.54, 95% CI − 17.96 to − 1.12, P = 0.03), higher surgical success rate (OR 3.80, 95% CI 1.76–8.22, P < 0.01), fewer complications(OR 0.18, 95% CI 0.08–0.39, P < 0.01), higher patency rate after 3 months (OR 4.91, 95% CI 1.19–20.33, P = 0.03), higher patency rate after 6 months (OR 1.90, 95%CI 1.09–3.31, P = 0.02), higher patency rate after 12 months (OR 1.70, 95% CI 1.09–2.66, P = 0.02). There was no difference after the two arteriovenous (AVF) anastomosisl methods concerning AVF maturation time (SMD − 0.48, 95% CI − 1.30–0.34, P = 0.25) and patency rate after 1 month (OR 1.77, 95% CI 0.65–4.80, P = 0.26). Conclusion Functional ETS anastomosis had advantages of easy operation, high surgical success rate, few complications, high patency rate of 3 months and long-term, but did not have obvious advantage in the early stages concerning AVF maturation time and 1-month patency rate.

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CPAP as treatment of sleep apnea after stroke

Neurology ◽

10.1212/wnl.0000000000005262 ◽

2018 ◽

Vol 90 (14) ◽

pp. e1222-e1230 ◽

Cited By ~ 27

Author(s):

Anne-Kathrin Brill ◽

Thomas Horvath ◽

Andrea Seiler ◽

Millene Camilo ◽

Alan G. Haynes ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Meta Analysis ◽

Cochrane Library ◽

Dropping Out ◽

Vascular Events ◽

Term Survival ◽

Neurologic Recovery ◽

Mean Differences ◽

The Cochrane Library

ObjectiveTo perform a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effectiveness of continuous positive airway pressure (CPAP) in stroke patients with sleep disordered breathing (SDB).MethodsIn a systematic literature search of electronic databases (MEDLINE, Embase, and the Cochrane Library) from 1980 to November 2016, we identified RCTs that assessed CPAP compared to standard care or sham CPAP in adult patients with stroke or TIA with SDB. Mean CPAP use, odds ratios (ORs), and standardized mean differences (SMDs) were calculated. The prespecified outcomes were adherence to CPAP, neurologic improvement, adverse events, new vascular events, and death.ResultsTen RCTs (564 participants) with CPAP as intervention were included. Two studies compared CPAP with sham CPAP; 8 compared CPAP with usual care. Mean CPAP use across the trials was 4.53 hours per night (95% confidence interval [CI] 3.97–5.08). The OR of dropping out with CPAP was 1.83 (95% CI 1.05–3.21, p = 0.033). The combined analysis of the neurofunctional scales (NIH Stroke Scale and Canadian Neurological Scale) showed an overall neurofunctional improvement with CPAP (SMD 0.5406, 95% CI 0.0263–1.0548) but with a considerable heterogeneity (I2 = 78.9%, p = 0.0394) across the studies. Long-term survival was improved with CPAP in 1 trial.ConclusionCPAP use after stroke is acceptable once the treatment is tolerated. The data indicate that CPAP might be beneficial for neurologic recovery, which justifies larger RCTs.

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Adverse Events Associated With Anti-IL-23 Agents: Clinical Evidence and Possible Mechanisms

Frontiers in Immunology ◽

10.3389/fimmu.2021.670398 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yi Ru ◽

Xiaojie Ding ◽

Ying Luo ◽

Hongjin Li ◽

Xiaoying Sun ◽

...

Keyword(s):

Clinical Trials ◽

Adverse Event ◽

Adverse Events ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cochrane Library ◽

The Cochrane Library ◽

Specific Symptoms

BackgroundAnti-interleukin (IL)-23 agents are widely used for autoimmune disease treatment; however, the safety and risks of specific symptoms have not been systematically assessed.ObjectivesThe aim of this study was to summarize the characteristics and mechanisms of occurrence of five immunological and non-immunological adverse events caused by different anti-IL-23 agents.MethodsThe Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched for eligible randomized clinical trials published from inception through May 1, 2020. Randomized clinical trials that reported at least one type of adverse event after treatment were included, regardless of sex, age, ethnicity, and diagnosis. Two investigators independently screened and extracted the characteristics of the studies, participants, drugs, and adverse event types. The Cochrane Handbook was used to assess the methodological quality of the included randomized clinical trials. Heterogeneity was assessed using the I2 statistic. Meta-regression was applied to determine the sources of heterogeneity, and subgroup analysis was used to identify the factors contributing to adverse events.ResultsForty-eight studies were included in the meta-analysis, comprising 25,624 patients treated with anti-IL-23 agents. Serious immunological or non-immunological adverse events were rare. Anti-IL-12/23-p40 agents appeared to cause adverse events more easily than anti-IL-23-p19 agents. The incidence of cancer did not appear to be related to anti-IL-23 agent treatment, and long-term medication could lead to mental diseases. The prevention of complications should be carefully monitored when administered for over approximately 40 weeks to avoid further adverse reactions, and the incidence of infection was the highest among general immunological adverse events.ConclusionsThe application of anti-IL-23 agents induced a series of immunological and non-immunological adverse events, but these agents tend to be well-tolerated with good safety profiles.

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