Extra-Corporeal Membrane Oxygenation (ECMO) for Postcardiotomy Cardiogenic Shock (PCCS) in Asian Patients: A Systematic Review and Meta-Analysis

Abstract Background Extra-corporeal membrane oxygenation (ECMO) is an important extracorporeal life support system to treat patients with postcardiotomy cardiogenic shock (PCCS). But its effectiveness and safety are still inconclusive. Existing systematic reviews and meta-analysis have heterogeneity challenges such as the inclusion of different races in the same study.Objective The impact of ECMO treatment on the survival rate of Asian adult patients with PCCS was evaluated by searching the literature and using the method of systematic review and meta-analysis.Study Design and Methods PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, WANFANG MED ONLINE, SinoMed were searched to find relevant research on the use of ECMO on PCCS patients in Asia. Outcomes included survival rate to hospital discharge, long-term survival rate, complications.Results A total of 32 articles were selected, including observational studies and one RCT, involving China and Japan covering 4,278 PCCS patients. The pooled rate of survival to hospital discharge was 43.0% (95% CI 38% ~47%, I2 = 87%), the pooled 1-year, 2-year, and 3-year survival rate were 34% (95% CI 26% ~ 42%, I2 = 85%), 29% (95% CI 18% ~39%, I2 = 93%), 25% (95%CI 16% ~35%, I2=93%). The pooled rate of bleeding, neurologic complications, rethoracotomy, leg ischemia, renal failure, renal replacement therapy, and infection were 18% (95% CI 13% ~24%, I2=91%), 13% (95% CI 9% ~17%, I2 = 90.0%), 36% (95% CI 27% ~46%, I2 = 97.0%), 11% (95% CI 9% ~13%, I2 = 55%), 40% (95% CI 27% ~54%, I2 = 90%), 45% (95% CI 35% ~ 56%, I2 = 98%), 26% (95%CI (20%~31%, I2=95%).Conclusion ECMO can provide survival benefits for Asian adult patients with PCCS. However, attention should be paid to reducing the incidence of complications, especially renal failure. More high-quality clinical studies are needed to confirm the survival benefit of ECMO.