The impact of Centre’s heart transplant status and volume on in-hospital outcomes following extracorporeal membrane oxygenation for refractory post-cardiotomy cardiogenic shock: a meta-analysis
Posted on 2020-01-10 - 04:52
Abstract Background Postcardiotomy cardiogenic shock (PCS) that is refractory to inotropic support remains a major concern in cardiac surgery and is almost universally fatal unless treated with mechanical support. While reported mortality rates on ECMO vary from center to center, aim of the current report is assess if the outcomes differ between centres according to volume and heart transplantation status. Methods A systematic search was performed according to PRISMA statement using PubMed/Medline databases between 2010 and 2018. Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and heart transplantation status of the centre. Paediatric and congenital heart surgery-related studies along with those conducted in the setting of veno-venous ECMO for respiratory distress syndrome were excluded. Differences were assessed by means of subgroup meta-analysis and meta-regression. Results Fifty-four studies enrolling N = 4421 ECMO patients were included. Of those, 6 series were performed in non-HTx centres (204 pts.;4.6%). Overall 30-day survival (95% Confidence Intervals) was 35.3% (32.5–38.2%) and did not statistically differ between non-HTx: 33.3% (26.8–40.4%) and HTx centres: 35.7% (32.7–38.8%); Pinteraction = 0.531. There was no impact of centre volume on survival as well: ßcoef = 0.0006; P = 0.833. No statistical differences were seen between HTx and non-HTx with respect to ECMO duration, limb complications, reoperations for bleeding, kidney injury and sepsis. There were however significantly less neurological complications in the HTx as compared to non-HTx centres: 11.9% vs 19.5% respectively; P = 0.009; an inverse relationship was seen for neurologic complications in centres performing more ECMOs annually ßcoef = − 0.0066; P = 0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx facilities. Conclusions There was no apparent difference in survival after ECMO implantation for refractory PCS according to centre’s ECMO volume and transplantation status. Potentially different risk profiles of patients in these centres must be taken account for before definite conclusions are drawn.
CITE THIS COLLECTION
DataCite
3 Biotech
3D Printing in Medicine
3D Research
3D-Printed Materials and Systems
4OR
AAPG Bulletin
AAPS Open
AAPS PharmSciTech
Abhandlungen aus dem Mathematischen Seminar der Universität Hamburg
ABI Technik (German)
Academic Medicine
Academic Pediatrics
Academic Psychiatry
Academic Questions
Academy of Management Discoveries
Academy of Management Journal
Academy of Management Learning and Education
Academy of Management Perspectives
Academy of Management Proceedings
Academy of Management Review
Kowalewski, Mariusz; Raffa, Giuseppe; Zieliński, Kamil; Alanazi, Musab; Gilbers, Martijn; Heuts, Sam; et al. (2020). The impact of Centre’s heart transplant status and volume on in-hospital outcomes following extracorporeal membrane oxygenation for refractory post-cardiotomy cardiogenic shock: a meta-analysis. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4812189.v1
or
Select your citation style and then place your mouse over the citation text to select it.
SHARE
Usage metrics
AUTHORS (18)
MK
Mariusz Kowalewski
GR
Giuseppe Raffa
KZ
Kamil Zieliński
MA
Musab Alanazi
MG
Martijn Gilbers
SH
Sam Heuts
EN
Ehsan Natour
EB
Elham Bidar
RS
Rick Schreurs
TD
Thijs Delnoij
RD
Rob Driessen
JS
Jan-Willem Sels
MP
Marcel Poll
PR
Paul Roekaerts
PM
Paolo Meani
JM
Jos Maessen
PS
Piotr Suwalski
RL
Roberto Lorusso