Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and Meta-Analysis.

OBJECTIVE

To investigate the clinical outcomes of adult patients receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock (PCS).

DESIGN

Meta-analysis of 20 observational studies.

SETTING

Hospitals that perform cardiac surgery.

PARTICIPANTS

The study included 2,877 PCS patients undergoing ECMO from 20 observational studies.

INTERVENTIONS

ECMO use.

MEASUREMENTS AND MAIN RESULTS

Twenty observational studies were selected for final analysis. The pooled survival rate to hospital discharge was 34.0% (30.0%-38.0%) in PCS patients receiving ECMO. The pooled 1-year survival rate was 24.0% (19.05%-30.0%). The pooled midterm survival rate was 18.0% (11.0%-27.0%). The pooled rate of leg ischemia was 14.0% (10.0%-20.0%). The pooled rate of redo surgery was 50.0% (32.0%-68.0%). The pooled rate of renal failure was 57.0% (47.0%-66.0%). The pooled rate of neurologic complications was 16.0% (13.0%-20.0%). The pooled rate of infection was 31.0% (22.0%-41.0%). Most of the included studies commonly revealed that age >65 years, pre-ECMO or post-ECMO blood lactate, renal insufficiency, a longer duration of ECMO, and neurologic complications were risk factors of in-hospital mortality in PCS patients undergoing ECMO.

CONCLUSIONS

The short-term and midterm survival rates of PCS patients treated with ECMO were disappointingly low, and post-ECMO complication rates were relatively high.