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. 2019 Jan;8(1):1-8.
doi: 10.21037/acs.2018.11.09.

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Ashley R Wilson-Smith  1   2 , Yulia Bogdanova  2 , Stephanie Roydhouse  2 , Kevin Phan  1 , David H Tian  1   3 , Tristan D Yan  1   4 , Antonio Loforte  5
Affiliations

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

Ashley R Wilson-Smith et al. Ann Cardiothorac Surg. 2019 Jan.

Abstract

Background: Despite advances in management techniques and medical therapy, refractory cardiogenic shock remains a life-threatening condition with high mortality rates. The present systematic review and meta-analysis aims to explore the outcomes associated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in the setting of refractory cardiogenic shock, stratified per survivorship.

Methods: A literature search was performed using three electronic databases from the date of their inception up to June 2018. The literature search and subsequent data extraction were performed by two independent reviewers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and were subsequently aggregated for analysis.

Results: Fifty-two studies were included, with 44 undergoing quantitative analysis. A total of 17,515 patients were identified, with a mean age of 58.4±9.4 years and a mean duration of ECMO support of 5.1±2.6 days; 68.7% of the patients were male. Aggregated survival rates at 1, 2, 3 and 5 years were 36.7%, 34.8%, 33.8% and 29.9%, respectively.

Conclusions: The present systematic review illustrates the expected survival results for VA-ECMO in the intermediate- to long-term. Extended follow-up and standardized reporting measures are urgently needed in order to carry out more definitive subgroup analyses.

Keywords: ECLS; Extracorporeal membrane oxygenation (ECMO); refractory cardiogenic shock.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Aggregated survival for the entire cohort using Kaplan-Meier estimation.
Figure S1
Figure S1
PRISMA flow chart detailing the literature search process for contemporary VA-ECMO outcomes in the setting of cardiogenic shock. ECMO, extracorporeal membrane oxygenation.
Figure S2
Figure S2
Forest plot analysis: in-hospital complications. Forest plot analysis illustrating outcomes; survivors (i.e., experimental) compared to non-survivors (i.e., control). Note: survivors were less likely to have infection in this analysis, but the result is not statistically significant.
See this image and copyright information in PMC

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