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.

Background 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. Methods A systemic search was conducted in PubMed from 1975 to 2018. Among 4,121articles, a total of 35 clinical reports comprising 20,610patients (1,631of the patients who underwent ECMO and 18,979of the patients who did not undergo ECMO) met the inclusion criteria. Results The pooled hazard ratio (HR) of 1.2828(95% confidence interval (CI): 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. With respect to the individual indication of respiratory failure as a subgroup analysis, the ECMO group showed significantly improved patient survival, with a pooled HR of 0.6308 (95% CI: 0.5037, 0.7900). 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. Greater attention to designing the randomized controlled trials and reporting HRs of ECMO outcomes are needed.

ECMO inevitably increases the risk of infection over time; therefore, lowering infections acquired during ECMO should be further investigated and developed accordingly (Bizzarro,2011). The degree of dysfunction by ECMO is evaluated using several methods, namely: ultrastructural changes in gut epithelium by TEM, plasma lipopolysaccharide (LPS) levels of bacterial products after receiving ECMO, etc. In particular, bacterial lipoteichoic acid (LTA) antigens in plasma can be measured over time by Westernblotlaboratory technique in association with the loss of gut barrier function below. The purpose of this pilot study is to evaluate how newly-developed ECMO reduces infection levels by controlling and stabilizing the overall hemodynamic status, based on the outcome of a Westernblot.

IMPORTANCE: This review provides a comprehensive comparison of treatment outcomes between robot-assisted laparoscopic surgery (RLS) and conventional laparoscopic surgery (CLS) based on randomly-controlled trials (RCTs). OBJECTIVES: We employed RCTs to provide a systematic review that will enable the relevant community to weigh the effectiveness and efficacy of surgical robotics in controversial fields on surgical procedures both overall and on each individual surgical procedure. EVIDENCE REVIEW: A search was conducted for RCTs in PubMed, EMBASE, and Cochrane databases from 1981 to 2016. Among a total of 1,517 articles, 27 clinical reports with a mean sample size of 65 patients per report (32.7 patients who underwent RLS and 32.5 who underwent CLS), met the inclusion criteria. FINDINGS: CLS shows significant advantages in total operative time, net operative time, total complication rate, and operative cost (p < 0.05 in all cases), whereas the estimated blood loss was less in RLS (p < 0.05). As subgroup analyses, conversion rate on colectomy and length of hospital stay on hysterectomy statistically favors RLS (p < 0.05). CONCLUSIONS: Despite higher operative cost, RLS does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with CLS. More RCT evidence is needed to be accumulated in order to enable full subgroup analyses on each surgical procedure.