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Meta-analysis to Assess the Impact of Centre’s Heart Transplant Status and Volume on in-hospital Outcomes Following Extracorporeal Membrane Oxygenation for Refractory Post-cardiotomy Cardiogenic Shock

Mariusz Kowalewski, Giuseppe Raffa, Kamil Zielinski, Musab Alanazi, Martijn Gilbers, Sam Heuts, Ehsan Natour, Elham Bidar, Rick Schreurs, Thijs Delnoij, Rob Driessen, Jan Willem Sels, Marcel van de Poll, Paul Roekaerts, Paolo Meani, Jos Maessen, Piotr Suwalski, Roberto Lorusso
DOI: 10.21203/rs.2.12508/v1

Abstract

Background: Postcardiotomy cardiogenic shock (PCS) that is refractory to inotropic support remains a major concern in cardiac surgery and is almost universally fatal unless treated with mechanical support. While reported mortality rates on ECMO vary from center to center, aim of the current report is assess if the outcomes differ between centres according to volume and heart transplantation status.

Methods: A systematic search was performed according to PRISMA statement using PubMed/Medline databases between 2010 and 2018. Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and heart transplantation status of the centre. Differences were assessed by means of subgroup meta-analysis and meta-regression.

Results: Fifty-four studies enrolling N=4,421 ECMO patients were included. Of those, 6 series were performed in non-HTx centres (204 pts;4.6%). Overall 30-day survival (95% Confidence Intervals) was 35.3% (32.5-38.2%) and did not statistically differ between non-HTx: 33.3% (26.8-40.4%) and HTx centres: 35.7% (32.7-38.8%); Pinteraction=0.531. There was no impact of centre volume on survival as well: ßcoef=0.0006; P=0.833. No statistical differences were seen between HTx and non-HTx with respect to ECMO duration, limb complications, reoperations for bleeding, kidney injury and sepsis. There were however significantly less neurological complications in the HTx as compared to non-HTx centres: 11.9% vs 19.5% respectively; P=0.009; an inverse relationship was seen for neurologic complications in centres performing more ECMOs annually ßcoef=-0.0066; P=0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx facilities.

Conclusions: There was no apparent difference in survival after ECMO implantation for refractory PCS according to centre’s ECMO volume and transplantation status. Potentially different risk profiles of patients in these centres must be taken account for before definite conclusions are drawn.

Keywords
Extracorporeal Membrane Oxygenation; Extracorporeal Life Support; Cardiogenic Shock; Meta-Analysis

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Preprint: Please note that this article has not completed peer review.

Meta-analysis to Assess the Impact of Centre’s Heart Transplant Status and Volume on in-hospital Outcomes Following Extracorporeal Membrane Oxygenation for Refractory Post-cardiotomy Cardiogenic Shock

Mariusz Kowalewski, Giuseppe Raffa, Kamil Zielinski, Musab Alanazi, Martijn Gilbers, Sam Heuts, Ehsan Natour, Elham Bidar, Rick Schreurs, Thijs Delnoij, Rob Driessen, Jan Willem Sels, Marcel van de Poll, Paul Roekaerts, Paolo Meani, Jos Maessen, Piotr Suwalski, Roberto Lorusso

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Abstract

Background: Postcardiotomy cardiogenic shock (PCS) that is refractory to inotropic support remains a major concern in cardiac surgery and is almost universally fatal unless treated with mechanical support. While reported mortality rates on ECMO vary from center to center, aim of the current report is assess if the outcomes differ between centres according to volume and heart transplantation status.

Methods: A systematic search was performed according to PRISMA statement using PubMed/Medline databases between 2010 and 2018. Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and heart transplantation status of the centre. Differences were assessed by means of subgroup meta-analysis and meta-regression.

Results: Fifty-four studies enrolling N=4,421 ECMO patients were included. Of those, 6 series were performed in non-HTx centres (204 pts;4.6%). Overall 30-day survival (95% Confidence Intervals) was 35.3% (32.5-38.2%) and did not statistically differ between non-HTx: 33.3% (26.8-40.4%) and HTx centres: 35.7% (32.7-38.8%); Pinteraction=0.531. There was no impact of centre volume on survival as well: ßcoef=0.0006; P=0.833. No statistical differences were seen between HTx and non-HTx with respect to ECMO duration, limb complications, reoperations for bleeding, kidney injury and sepsis. There were however significantly less neurological complications in the HTx as compared to non-HTx centres: 11.9% vs 19.5% respectively; P=0.009; an inverse relationship was seen for neurologic complications in centres performing more ECMOs annually ßcoef=-0.0066; P=0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx facilities.

Conclusions: There was no apparent difference in survival after ECMO implantation for refractory PCS according to centre’s ECMO volume and transplantation status. Potentially different risk profiles of patients in these centres must be taken account for before definite conclusions are drawn.

Figures

Background

Material and methods

Results

Discussion

Abbreviations

Declarations

References

Tables

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