Prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation therapy: A systematic review and proportional meta-analysis

Abstract

Objectives: To pool the overall prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation (ECMO) support.

Methodology: This systematic review and proportional meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Six electronic databases including PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and PsycINFO were searched from inception to March 2023. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. A random effects model was used to pool the summary prevalence estimates and 95% CIs using the score statistic and the exact binomial method and incorporates the Freeman-Tukey double arcsine transformation of proportions. Sensitivity analyses including subgroup analysis, meta-regression, and outlier detection were carried out.

Setting: Intensive care units.

Main outcome measures: Prevalence of delirium.

Results: A total of 10 studies involving 8,580 patients were included for meta-analysis. All studies had a low risk of bias in methodological quality. The pooled prevalence rate of 40.79% [95% CI, 17.58%-66.25%] was observed. The between-study heterogeneity (I²) was 98.28%. The subgroup analysis reveals the pooled prevalence of delirium for veno-arterial (V-A) ECMO, veno-venous (V-V) ECMO, and mixed sample of V-A and V-V ECMO were 63.57% [95% CI, 55.77%-71.04%], 51.84% [95% CI, 37.43%-66.12%] and 35.23% [95% CI, 11.84%-62.95%], respectively. Sample size (p = 0.024) was a significant factor associated with the heterogeneity. No evidence for small-study effects was observed (Egger's test: p = 0.5664).

Conclusion: This systematic review and proportional meta-analysis reveals a high prevalence of delirium among critically ill patients who received ECMO support.

Implications for clinical practice: The results of this meta-analysis can be epidemiological evidence to inform the awareness of clinicians and researchers in critical care clinical practice and research.

Keywords: Critical care nursing; Delirium; Extracorporeal membrane oxygenation; Meta-analysis prevalence.