Clinical outcomes of heart dysfunction treated by extracorporeal membrane oxygenation (ECMO): a meta-analysis

doi:10.3877/cma.j.issn.2096-1537.2021.04.011

Abstract

Abstract:

Objective

To compare the clinical outcomes of patients with heart dysfunction treated with extracorporeal membrane oxygenation (ECMO).

Methods

PubMed, the Cochrane Library, Embase and Web of Science were searched from January 1, 1970 to December 31, 2020. Statistical analysis were performed using comprehensive meta-analysis statistical software, version 2.0.

Results

After screening for the relevant studies, 18 studies with 729 patients meeting the inclusion criteria were ultimately included. The results of the meta-analysis revealed that in patients with heart dysfunction who received ECMO intervention, the 1-month mortality rate was 36.7% (95%CI: 0.034-0.905), and in-hospital mortality was 39.8% (95%CI: 0.256-0.560). In addition, 3-month survival rate was 72.8% (95%CI: 0.621-0.814), 6-month hospitalization survival rate was 65.4% (95%CI: 0.522-0.767), and overall survival rate was 67.4% (95%CI: 0.485-0.820). Substantial heterogeneity was observed, however, sensitivity analysis showed the combined estimates were robust. No obvious publication bias existed.

Conclusion

The mid-term survival rates of patients with heart dysfunction treating by ECMO are about 60%. Future studies based on controlled trials are warranted. Subgroup analyses by different ventricular assistant device are also suggested.

Key words: Extracorporeal membrane oxygenation, Heart dysfunction, Critical care medicine

Fei Yang, Shaohua Wang, Zhuang Chen, Hui Shi, Yun Long. Clinical outcomes of heart dysfunction treated by extracorporeal membrane oxygenation (ECMO): a meta-analysis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 347-354.

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References 28

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研究者	年份	辅助装置	例数	年龄（岁）	男性比例［例（%）］	病死率	生存率
Djordjevic，I	2020	无	64	63±14	42（68）	1个月病死率88%	-
Riebandt，J	2018	左心室辅助	32	52±14	27（84.4）	1个月病死率18.8%，住院病死率25%	1年生存率75%
den Uil，CA	2017	-	29	40±16	12（41）	3个月病死率38%	3个月生存率62%
Fischer，Q	2018	左心室辅助+右心室辅助	44	58.2±12.3	38（86）	-	1、3、6个月生存率 88.4%，78.2%，66.1%
Shehab，S	2018	左心室辅助	112	51±14	90（80）	-	1年生存率78%
Han，JJ	2018	左心室辅助	18	54±16	14（78）	-	1年生存率77%
Leidenfrost，J	2016	左心室辅助+右心室辅助	12	45.6±16	-	1个月病死率8%	3、6个月、1年生存率 86%，63% and 54%
Schoenrath，F	2016	左心室辅助+双心室辅助	57	46.8±15.5	13（43.3）	-	1、2、4年生存率6.8%，32.2% and 29.8%
Acheampong，B	2016	无	24	41（22~75）	14（58.3）	住院病死率54%	住院生存率 46%
Noly，PE	2014	左心室辅助	8	50.8±9.9	5（62.5）	病死率50.00%	-
Scherer，M	2011	左心室辅助	10	53±10	9（90）	-	总生存率60%
Chou，NK	2010	-	14	-	-	-	总生存率69.2%
Bautista-Hernandez，V	2009	无	26	0.12（0~193）*	18（69）	-	住院生存率62%
Luo，XJ	2009	无	45	49.0±14.1	34（76）	住院病死率42%	住院生存率58%
Scherer，M	2009	左心室辅助	5	47±11	4（80）	-	总生存率80%
Liu，KS	2009	无	14	55.7±15.4	7（50）	-	住院生存率64%
Taghavi，S	2004	左心室辅助+右心室辅助	13	51.3±15.6	10（77）	-	住院生存率43%
Smedira，NG	2001	无	202	55±14	145（72）	-	1个月、1年生存率8%，24%

研究者	年份	辅助装置	例数	年龄（岁）	男性比例［例（%）］	病死率	生存率
Djordjevic，I	2020	无	64	63±14	42（68）	1个月病死率88%	-
Riebandt，J	2018	左心室辅助	32	52±14	27（84.4）	1个月病死率18.8%，住院病死率25%	1年生存率75%
den Uil，CA	2017	-	29	40±16	12（41）	3个月病死率38%	3个月生存率62%
Fischer，Q	2018	左心室辅助+右心室辅助	44	58.2±12.3	38（86）	-	1、3、6个月生存率 88.4%，78.2%，66.1%
Shehab，S	2018	左心室辅助	112	51±14	90（80）	-	1年生存率78%
Han，JJ	2018	左心室辅助	18	54±16	14（78）	-	1年生存率77%
Leidenfrost，J	2016	左心室辅助+右心室辅助	12	45.6±16	-	1个月病死率8%	3、6个月、1年生存率 86%，63% and 54%
Schoenrath，F	2016	左心室辅助+双心室辅助	57	46.8±15.5	13（43.3）	-	1、2、4年生存率6.8%，32.2% and 29.8%
Acheampong，B	2016	无	24	41（22~75）	14（58.3）	住院病死率54%	住院生存率 46%
Noly，PE	2014	左心室辅助	8	50.8±9.9	5（62.5）	病死率50.00%	-
Scherer，M	2011	左心室辅助	10	53±10	9（90）	-	总生存率60%
Chou，NK	2010	-	14	-	-	-	总生存率69.2%
Bautista-Hernandez，V	2009	无	26	0.12（0~193）*	18（69）	-	住院生存率62%
Luo，XJ	2009	无	45	49.0±14.1	34（76）	住院病死率42%	住院生存率58%
Scherer，M	2009	左心室辅助	5	47±11	4（80）	-	总生存率80%
Liu，KS	2009	无	14	55.7±15.4	7（50）	-	住院生存率64%
Taghavi，S	2004	左心室辅助+右心室辅助	13	51.3±15.6	10（77）	-	住院生存率43%
Smedira，NG	2001	无	202	55±14	145（72）	-	1个月、1年生存率8%，24%

研究者	年份	对象的选择				群体可比性	结局评估			合计
研究者	年份	1^*	2^*	3^*	4^*	5^*	6^*	7^*	8^*	合计
Djordjevic，I	2020	1	0	1	1	1	1	1	1	7
Riebandt，J	2018	1	0	1	1	1	2	1	1	8
den Uil，CA	2018	1	0	1	1	1	1	0	1	6
Fischer，Q	2018	1	0	1	1	1	0	1	1	6
Shehab，S	2018	1	0	1	1	1	1	1	0	6
Han，JJ	2018	1	0	1	1	1	1	1	1	7
Leidenfrost，J	2016	1	0	1	1	1	1	1	0	6
Schoenrath，F	2016	1	0	1	1	1	2	1	1	8
Acheampong，B	2016	1	0	1	1	1	1	1	1	7
Noly，PE	2014	1	0	1	1	1	1	1	0	6
Scherer，M	2011	1	0	1	1	1	1	1	0	6
Chou，NK	2010	1	0	1	1	1	1	0	1	6
Bautista-Hernandez，V	2009	1	0	1	1	1	1	1	0	6
Luo，XJ	2009	1	0	1	1	1	1	1	1	7
Scherer，M	2009	1	0	1	1	1	1	1	1	7
Liu，KS	2009	1	0	1	1	1	2	1	1	8
Taghavi，S	2004	1	0	1	1	1	1	1	1	7
Smedira，NG	2001	1	0	1	1	1	2	1	1	8

研究者	年份	对象的选择				群体可比性	结局评估			合计
研究者	年份	1^*	2^*	3^*	4^*	5^*	6^*	7^*	8^*	合计
Djordjevic，I	2020	1	0	1	1	1	1	1	1	7
Riebandt，J	2018	1	0	1	1	1	2	1	1	8
den Uil，CA	2018	1	0	1	1	1	1	0	1	6
Fischer，Q	2018	1	0	1	1	1	0	1	1	6
Shehab，S	2018	1	0	1	1	1	1	1	0	6
Han，JJ	2018	1	0	1	1	1	1	1	1	7
Leidenfrost，J	2016	1	0	1	1	1	1	1	0	6
Schoenrath，F	2016	1	0	1	1	1	2	1	1	8
Acheampong，B	2016	1	0	1	1	1	1	1	1	7
Noly，PE	2014	1	0	1	1	1	1	1	0	6
Scherer，M	2011	1	0	1	1	1	1	1	0	6
Chou，NK	2010	1	0	1	1	1	1	0	1	6
Bautista-Hernandez，V	2009	1	0	1	1	1	1	1	0	6
Luo，XJ	2009	1	0	1	1	1	1	1	1	7
Scherer，M	2009	1	0	1	1	1	1	1	1	7
Liu，KS	2009	1	0	1	1	1	2	1	1	8
Taghavi，S	2004	1	0	1	1	1	1	1	1	7
Smedira，NG	2001	1	0	1	1	1	2	1	1	8

结果	文献	统计结果
结果	文献	分数	95%CI	P值
1个月病死率	Riebandt，J（2018）	0.472	0.011~0.986	0.959
	Leidenfrost，J（2016）	0.568	0.043~0.975	0.874
	Djordjevic，I（2020）	0.166	0.081~0.311	0.000
	合并计算（随机模型）	0.367	0.034~0.905	0.704
住院病死率	Riebandt，J（2018）	0.462	0.348~0.580	0.530
	Luo，XJ（2009）	0.385	0.154~0.682	0.456
	Acheampong，B（2016）	0.340	0.195~0.523	0.085
	合并计算（随机模型）	0.398	0.256~0.560	0.216

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