Search

Purpose:Time-to-event data of hazard ratios were used to generate a forest plot of all-cause mortality on extracorporeal membrane oxygenation (ECMO) in both overall and individual indications of cardiopulmonary disease in adults. Materials and Methods:A systemic search was conducted in PubMed from 1975 to 2018. Among 4,121 articles, a total of 34 clinical reports comprising 20,610patients (1,631 of the patients who underwent ECMO and 18,979 of the patients who did not undergo ECMO) met the inclusion criteria. Results:The pooled hazard ratio of 1.2828 (95% confidence interval: 0.9649, 1.7054) suggests that the ECMO group was not significantly associated with a reduction in mortality compared with the no-ECMO group in the overall ECMO indications. The results of subgroup analyses showed a significantly improved patient survival in respiratory failure with 0.6308 (0.5037, 0.7900), and a worse patient survival after lung transplantation with 2.0600 (1.6987, 2.4981), in bridging to heart transplantation with 1.4212 (1.0309, 1.9592), and after heart transplantation with 5.6365 (1.7569, 18.0827). Conclusions:Most of the included studies are retrospective, which diminishes the significance of the findings due to a higher risk of selection bias, which was exemplified by the allocation of ECMO based on the patients’ severity condition.

Purpose:Time-to-event data of hazard ratios were used to generate a forest plot of mortality on extracorporeal membrane oxygenation (ECMO) in respiratory failure in adults. Materials and Methods:A systemic search was conducted in PubMed from 1975 to 2018. Among 4,121 articles, a total of 5 clinical reports comprising 1,014patients (333 of the patients who underwent ECMO and 681 of the patients who did not undergo ECMO) met the inclusion criteria. Results:The pooled hazard ratio of 0.64 (95% confidence interval (CI): 0.54, 0.76) suggests that the ECMO group comprising both veno-arterial (VA) type and a majority of veno-venous (VV) type was significantly associated with a reduction in mortality compared with the non-ECMO group in respiratory failure. The results of VV-ECMO alone also showed significantly improved patient survival of respiratory failure with the hazard ratio of 0.67 (0.56, 0.81). Conclusions:The results of the ECMO group with VV and VA types, or the VV type alone revealed a reduction in mortality for patients with respiratory failure based on time-to-event data.Future investigation of the efficacy of VA-ECMO alone in respiratory failure may be more enlightening.