Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: a meta-analysis.Magouliotis DE, Tasiopoulou VS, et al.
General Thoracic & Cardiovascular Surgery 2017; 16: 16.
To conduct a meta-analysis and systematic review to compare the surgical outcomes of cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) during lung transplantation (LuTx).
The databases Pubmed, Cochrane Central Register of Controlled Studies and EBSCO HOST were searched until 20 March 2017. Original reports ≥ 10 patients, published in English between 2000 to 2017 reporting the outcomes of intraoperative CPB or ECMO on human patients undergoing LuTx were included. Two independent reviewers extracted data and any discrepancies were discussed with a third reviewer. The reference lists of all included articles were reviewed for additional potentially eligible studies.
Seven studies incorporating 785 patients were included.
Outcomes measured included type of surgical procedure, ischemic time, mean operative time, intraoperative transfusions, intubation/mechanical ventilation duration, intensive care unit stay, mean hospital stay, postoperative transfusions, postoperative forced expiratory volume in the first second, complications, and mortality rate.
This systematic review compared cardiopulmonary bypass (CPB) to extra-corporeal membrane oxygenation (ECMO) during lung transplantation. 7 studies were included (785 patients), and all studies were retrospective in nature. They were assessed for quality using the Newcastle-Ottawa scale. There were considerable differences in the cohorts of patients receiving each of these treatments; CPB was used in cases of increased risk of intraoperative bleeding and combined cardiac defects. In fact, patients in the CPB group who underwent concomitant cardiac procedures were reported in four studies, while only one study included patients with combined cardiac operations in the ECMO group. A meta-analysis was done and levels of heterogeneity were generally low except for primary graft dysfunction (I squared= 79%). In the meta-analysis, the total operation time was slightly longer for CPB and total support time was also longer. Transfusion of red blood cells was significantly higher for CPB. CPB was associated with increased blood loss, and higher levels of primary graft dysfunction, renal failure requiring dialysis and tracheostomy rates. There was no difference in stroke, AF or vascular complications. There were no significant differences in mortality rates up to one year. The results of this systematic review should certainly be interpreted with caution due to the different indications for use of each support method in most studies and their retrospective nature.
Quality assessment not appropriate