Extracorporeal membrane oxygenation vs cardiopulmonary bypass in lung transplantation: an updated meta-analysis.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2024-12-21 DOI:10.1007/s11748-024-02114-x

Rachid Eduardo Noleto da Nobrega Oliveira, Felipe S Passos, Bernardo Mulinari Pessoa

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引用次数: 0

Abstract

Aim: This meta-analysis aimed to compare the outcomes of extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass (CPB) in lung transplantation.

Methods: We searched PubMed, Embase, and Cochrane databases for studies comparing ECMO to CPB in lung transplantation. Odds ratios (ORs) for binary endpoints and mean differences (MDs) for continuous outcomes were calculated with 95% confidence intervals (CIs). DerSimonian and Laird random-effects model was applied for all endpoints. I² statistics was used to assess heterogeneity.

Results: Fourteen studies with a total of 1797 patients were included. ECMO was associated with significant reductions in hepatic dysfunction (OR 0.47, 95% CI 0.25-0.90), hemodialysis (OR 0.62, 95% CI 0.43-0.88), severe graft rejection (OR 0.43, 95% CI 0.23-0.78), one-year mortality (OR 0.70; 95% CI 0.51 to 0.98; p = 0.04; I² = 13%) and tracheostomy rates (OR 0.62, 95% CI 0.46-0.86). Additionally, ECMO reduced the length of hospital stay (MD - 5.69 days, 95% CI - 9.31 to - 2.08) and ICU stay (MD - 6.02 days, 95% CI - 8.32 to - 3.71). However, ECMO was associated with longer total ischemic time (MD 61.07 min, 95% CI 3.51 to 118.62). No significant differences were observed for stroke, thromboembolic events, atrial fibrillation, or 30-day and 3-year mortality.

Conclusions: ECMO offers perioperative advantages in lung transplantation, reducing postoperative complications, one-year mortality, and recovery time compared to CPB. However, the longer total ischemic time with ECMO warrants further investigation into its long-term outcomes.

Trial registry: International Prospective Register of Systematic Reviews; N°: CRD42024604049; URL: https://www.crd.york.ac.uk/prospero/ .

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肺移植的体外膜氧合与体外循环：一项最新的荟萃分析。

目的：本荟萃分析旨在比较体外膜氧合（ECMO）和体外循环（CPB）在肺移植中的效果。方法：我们检索PubMed， Embase和Cochrane数据库，比较ECMO和CPB在肺移植中的应用。以95%置信区间（ci）计算二元终点的优势比（ORs）和连续终点的平均差异（MDs）。所有终点均采用DerSimonian和Laird随机效应模型。采用I2统计来评估异质性。结果：纳入14项研究，共1797例患者。ECMO与肝功能障碍（OR 0.47, 95% CI 0.25-0.90）、血液透析（OR 0.62, 95% CI 0.43-0.88）、严重移植排斥反应（OR 0.43, 95% CI 0.23-0.78）、一年死亡率(OR 0.70；95% CI 0.51 ~ 0.98；p = 0.04；I2 = 13%)和气管造瘘率（OR 0.62, 95% CI 0.46-0.86）。此外，ECMO缩短了住院时间（MD - 5.69天，95% CI - 9.31至- 2.08）和ICU住院时间（MD - 6.02天，95% CI - 8.32至- 3.71）。然而，ECMO与较长的总缺血时间相关（MD 61.07 min, 95% CI 3.51 ~ 118.62）。卒中、血栓栓塞事件、房颤、30天和3年死亡率均无显著差异。结论：与CPB相比，ECMO在肺移植围手术期具有优势，减少了术后并发症、一年死亡率和恢复时间。然而，ECMO的总缺血时间较长，值得进一步研究其长期结果。试验注册：国际前瞻性系统评价注册；N°:CRD42024604049;网址：https://www.crd.york.ac.uk/prospero/。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.