Baseline surgical status and short-term mortality after extracorporeal membrane oxygenation for post-cardiotomy shock: a meta-analysis

Mariusz Kowalewski, Giuseppe Raffa, Kamil Zieliński, Paolo Meani, Musab Alanazi, Martijn Gilbers, Samuel Heuts, Ehsan Natour, Elham Bidar, Rick Schreurs, Thijs Delnoij, Rob Driessen, Jan Willem Sels, Marcel van de Poll, Paul Roekaerts, Jos Maessen, Piotr Suwalski, Roberto Lorusso

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: While reported mortality rates on post-cardiotomy extracorporeal membrane oxygenation vary from center to center, impact of baseline surgical status (elective/urgent/emergency/salvage) on mortality is still unknown. Methods: A systematic search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement using PubMed/Medline databases until March 2018 using the keywords “postcardiotomy,” “cardiogenic shock,” “extracorporeal membrane oxygenation,” and “extracorporeal life support.” Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and baseline surgical status. The correlations between mortality and percentage of elective/urgent/emergency cases were investigated. Inference analysis of baseline status and extracorporeal membrane oxygenation complications was conducted as well. Results: Twenty-two studies (conducted between 1993 and 2017) enrolling N = 2,235 post-cardiotomy extracorporeal membrane oxygenation patients were found. Patients were mostly of non-emergency status (65.2%). Overall in-hospital/30-day mortality event rate (95% confidence intervals) was 66.7% (63.3-69.9%). There were no differences in in-hospital/30-day mortality with respect to baseline surgical status in the subgroup analysis (test for subgroup differences; p = 0.406). Similarly, no differences between mortality in studies enrolling <50 versus ⩾50% of emergency/salvage cases was found: respective event rates were 66.9% (63.1-70.4%) versus 64.4% (57.3-70.8%); p = 0.525. Yet, there was a significant positive association between increasing percentage of emergency/salvage cases and rates of neurological complications (p < 0.001), limb complications (p < 0.001), and bleeding (p = 0.051). Incidence of brain death (p = 0.099) and sepsis (p = 0.134) was increased as well. Conclusion: Other factors than baseline surgical status may, to a higher degree, influence the mortality in patients treated with extracorporeal membrane oxygenation for post-cardiotomy cardiogenic shock. Baseline status, however, strongly influences the complication occurrence while on extracorporeal membrane oxygenation.

Original languageEnglish
JournalPerfusion (United Kingdom)
DOIs
Publication statusAccepted/In press - Jan 1 2019

Keywords

  • cardiogenic shock
  • extracorporeal life support
  • extracorporeal membrane oxygenation
  • meta-analysis
  • post-cardiotomy shock

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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