Extracorporeal membrane oxygenation for cardiogenic shock: a meta-analysis of mortality and complications

Abstract

Background Venoarterial extracorporeal membrane oxygenation (va-ECMO) is an advanced life support for critically ill patients with refractory cardiogenic shock. This temporary support bridges time for recovery, permanent assist, or transplantation in patients with high risk of mortality. However, the benefit of this modality is still subject of discussion and despite the continuous development of critical care medicine, severe cardiogenic shock remains associated with high mortality. Therefore, this work aims to analyze the current literature regarding in-hospital mortality and complication rates of va-ECMO in patients with cardiogenic shock. Methods We conducted a systematic review and meta-analysis of the most recent literature to analyze the outcomes of va-ECMO support. Using the PRISMA guidelines, Medline (PubMed) and Scopus (Elsevier) databases were systematically searched up to May 2022. Meta-analytic pooled estimation of publications variables was performed using a weighted random effects model for study size. Results Thirty-two studies comprising 12756 patients were included in the final analysis. Between 1994 and 2019, 62% (pooled estimate, 8493/12756) of patients died in the hospital. More than one-third of patients died during ECMO support. The most frequent complications were renal failure (51%, 693/1351) with the need for renal replacement therapy (44%, 4879/11186) and bleeding (49%, 1971/4523), bearing the potential for permanent injury or death. Univariate meta-regression analyses identified age over 60 years, shorter ECMO duration and presence of infection as variables associated with in-hospital mortality, while the studies reporting a higher incidence of cannulation site bleeding were unexpectedly associated with a reduced in-hospital mortality. Conclusions Extracorporeal membrane oxygenation is an invasive life support with a high risk of complications. We identified a pooled in-hospital mortality of 62% with patient age, infection and ECMO support duration being associated with a higher mortality. Protocols and techniques must be developed to reduce the rate of adverse events. Finally, randomized trials are necessary to demonstrate the effectiveness of va-ECMO in cardiogenic shock.

ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality

“…Our multivariable model identified hemorrhage (HR 1.73, p = 0.005) during ECMO support as an independent risk factor for death, which is well-established in current literature [ 8 , 9 ]. Furthermore, this potentially lethal complication is independent of the type of ECMO configuration [ 4 , 6 , 21 ].…”

“…We observed a one-year mortality of 40%, which is rather low when compared to the available literature. A recent meta-analysis on mortality in cardiogenic shock in va-ECMO patients found an in-hospital mortality of 62% [ 9 ]. This discrepancy may be partly explained by undefined or different etiologies of cardiogenic shock and significant heterogeneity of included studies in the meta-analysis.…”

“…Multiple studies tried to identify predictors and risk factors for adverse events and mortality during ECMO support; however, inconsistent results indicate a need for further research [ 2 , 3 , 4 , 5 , 6 , 7 ]. It is well-established that hemorrhage has a strong impact on mortality [ 8 , 9 ], but studies failed to identify unique risk factors for bleeding [ 10 , 11 , 12 , 13 , 14 , 15 ]. Recent studies showed that patients with thrombosis had lower mortality, questioning therapeutic anticoagulation during ECMO support [ 12 ].…”

Mechanical Assist Device-Assisted Percutaneous Coronary Intervention: The Use of Impella Versus Extracorporeal Membrane Oxygenation as an Emerging Frontier in Revascularization in Cardiogenic Shock

“…According to a study, the most often experienced adverse events were renal failure and bleeding (50.5% and 48.5%, respectively). Of the patients, 44.3% required renal replacement therapy [ 74 ].…”

“…The number of patients who died during ECMO support was more than one-third (37.4% of all patients). The percentage of patients who experienced cardiac arrest before or during ECMO implantation was 30.2% [ 74 ]. These findings can be accredited to the higher incidence of complications and adverse effects related to the use of ECMO.…”