Original articleAdult cardiacComplications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients
Section snippets
Study Selection
A systematic PubMed search using the terms ECMO, ECLS (extracorporeal life support), extracorporeal membrane oxygenation, and extracorporeal life support cross-referenced with the terms cardiac shock, cardiogenic shock, cardiopulmonary resuscitation, and cardiac arrest was conducted to reveal 959 papers, updated until November 14, 2012. In an attempt to keep the pooled analysis current, only studies published in the year 2000 and onward were included. Studies not accessible in the English
Results
Twenty studies were included in the analyses encompassing 1,866 patients (Table 1). Analyses encompassed 192 to 1,452 patients depending on the specific complication analyzed. The results are summarized in Table 2 and Figure 1. Seventeen studies reported survival to hospital discharge, with a cumulative survival rate of 534 of 1,529, and a range of 20.8% to 65.4%. Study populations were summarized into four categories based on indications for ECMO placement: postcardiotomy cardiogenic shock,
Comment
Although use of ECMO can result in survival to hospital discharge in patients who presumably would not have survived otherwise, our study found considerable associated morbidity with performance of this intervention. In the absence of large randomized trials with uniform indications for use of ECMO, meta-analysis represents the best available method for ascertaining complication rates.
We found different rates of complications associated with ECMO with our meta-analysis when compared with
References (33)
- et al.
Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients
J Thorac Cardiovasc Surg
(2008) - et al.
Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery
J Cardiothorac Vasc Anesth
(2010) - et al.
Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock
Ann Thorac Surg
(2009) - et al.
Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: treatment strategies and predictors of short-term and midterm survival
Resuscitation
(2010) - et al.
Extracorporeal membrane oxygenation for advanced refractory shock in acute and chronic cardiomyopathy
Ann Thorac Surg
(2011) - et al.
Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock
Resuscitation
(2012) - et al.
Resuscitation of non-postcardiotomy cardiogenic shock or cardiac arrest with extracorporeal life support: the role of bridging to intervention
Resuscitation
(2012) - et al.
Heart transplant recipients supported with extracorporeal membrane oxygenation: outcomes from a single-center experience
J Heart Lung Transplant
(2011) - et al.
Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support
Ann Thorac Surg
(2011) - et al.
Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support
Resuscitation
(2010)