Wincy Wing-Sze Ng, Ka-Chun Leung, Rex Wan-Hin Hui, Pauline Yeung Ng, Chun-Wai Ngai, Simon Wai-Ching Sin
{"title":"肥胖对接受体外膜氧合的患者预后的影响:一项系统综述和荟萃分析。","authors":"Wincy Wing-Sze Ng, Ka-Chun Leung, Rex Wan-Hin Hui, Pauline Yeung Ng, Chun-Wai Ngai, Simon Wai-Ching Sin","doi":"10.1177/03913988251315617","DOIUrl":null,"url":null,"abstract":"<p><p>Given the growing obesity pandemic, the impact of obesity on outcomes of Extracorporeal Membrane Oxygenation (ECMO) would be increasingly relevant to our daily practise. This meta-analysis aims to evaluate the impact of obesity on ECMO outcomes, integrating the latest evidence. Systematic literature search was conducted from inception until December 2024 on MEDLINE, Embase and the Cochrane Library using the terms 'ECMO', 'obesity', and their related terms. Twenty-eight studies were included from 2013 to 2024, including a total of 74,330 ECMO patients (Mean age 52.84 ± 13.55 years). Obese patients had a similar risk of in-hospital or 30-day mortality when compared to non-obese patients (Risk difference -2%, 95%CI -5% to -1%, <i>I</i><sup>2</sup> = 85%, <i>p</i> = 0.25). Subgroup analysis of patients on V-V-ECMO showed a trend towards lower mortality in obese patients which did not reach statistical significance (risk difference -6%, 95%CI -13% to 0%, <i><u>I</u></i><sup>2</sup> = 53%, <i>p</i> = 0.06). Subgroup analysis of patients on V-A-ECMO showed significantly higher mortality in obese patients (risk difference 5%, 95%CI 1% to 9%, <i>I</i><sup>2</sup> = 54%, <i>p</i> = 0.007). Regarding secondary outcomes, obesity had no significant association with major bleeding or thrombotic complications (Risk difference 0%, 95%CI -1% to 2%, <i>I</i><sup>2</sup> = 15%, <i>p</i> = 0.63). Obesity was associated with significantly shorter hospital length-of-stay (Mean difference -2.92 days, 95% CI -5.03 to -0.80, <i>I</i><sup>2</sup> = 74%, <i>p</i> = 0.007), but had no impact on ECMO duration (Mean difference 0.35 days, 95%CI -0.03 to 0.74, <i>I</i><sup>2</sup> = 41%, <i>p</i> = 0.07). In summary, our meta-analysis showed that obesity was a favourable prognostic factor in V-V-ECMO. However, obesity increased mortality in V-A-ECMO patients. The modality of ECMO support should be taken into consideration when evaluating ECMO candidacy in individual obese patients.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"211-215"},"PeriodicalIF":1.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of obesity on outcomes in patients receiving extracorporeal membrane oxygenation: A systematic review and meta-analysis.\",\"authors\":\"Wincy Wing-Sze Ng, Ka-Chun Leung, Rex Wan-Hin Hui, Pauline Yeung Ng, Chun-Wai Ngai, Simon Wai-Ching Sin\",\"doi\":\"10.1177/03913988251315617\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Given the growing obesity pandemic, the impact of obesity on outcomes of Extracorporeal Membrane Oxygenation (ECMO) would be increasingly relevant to our daily practise. This meta-analysis aims to evaluate the impact of obesity on ECMO outcomes, integrating the latest evidence. Systematic literature search was conducted from inception until December 2024 on MEDLINE, Embase and the Cochrane Library using the terms 'ECMO', 'obesity', and their related terms. Twenty-eight studies were included from 2013 to 2024, including a total of 74,330 ECMO patients (Mean age 52.84 ± 13.55 years). Obese patients had a similar risk of in-hospital or 30-day mortality when compared to non-obese patients (Risk difference -2%, 95%CI -5% to -1%, <i>I</i><sup>2</sup> = 85%, <i>p</i> = 0.25). Subgroup analysis of patients on V-V-ECMO showed a trend towards lower mortality in obese patients which did not reach statistical significance (risk difference -6%, 95%CI -13% to 0%, <i><u>I</u></i><sup>2</sup> = 53%, <i>p</i> = 0.06). Subgroup analysis of patients on V-A-ECMO showed significantly higher mortality in obese patients (risk difference 5%, 95%CI 1% to 9%, <i>I</i><sup>2</sup> = 54%, <i>p</i> = 0.007). Regarding secondary outcomes, obesity had no significant association with major bleeding or thrombotic complications (Risk difference 0%, 95%CI -1% to 2%, <i>I</i><sup>2</sup> = 15%, <i>p</i> = 0.63). Obesity was associated with significantly shorter hospital length-of-stay (Mean difference -2.92 days, 95% CI -5.03 to -0.80, <i>I</i><sup>2</sup> = 74%, <i>p</i> = 0.007), but had no impact on ECMO duration (Mean difference 0.35 days, 95%CI -0.03 to 0.74, <i>I</i><sup>2</sup> = 41%, <i>p</i> = 0.07). In summary, our meta-analysis showed that obesity was a favourable prognostic factor in V-V-ECMO. However, obesity increased mortality in V-A-ECMO patients. 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引用次数: 0
摘要
鉴于日益增长的肥胖流行病,肥胖对体外膜氧合(ECMO)结果的影响将日益与我们的日常实践相关。本荟萃分析旨在评估肥胖对ECMO结果的影响,整合最新证据。系统地检索了MEDLINE、Embase和Cochrane图书馆从成立到2024年12月的文献,检索词为“ECMO”、“肥胖”及其相关术语。2013 - 2024年共纳入28项研究,共计74330例ECMO患者(平均年龄52.84±13.55岁)。与非肥胖患者相比,肥胖患者在住院或30天内死亡的风险相似(风险差异-2%,95%CI -5%至-1%,I2 = 85%, p = 0.25)。采用V-V-ECMO的患者亚组分析显示,肥胖患者死亡率有降低的趋势,但差异无统计学意义(风险差-6%,95%CI -13% ~ 0%, I2 = 53%, p = 0.06)。采用V-A-ECMO的患者亚组分析显示,肥胖患者的死亡率明显更高(风险差为5%,95%CI为1% ~ 9%,I2 = 54%, p = 0.007)。关于次要结局,肥胖与大出血或血栓并发症无显著相关性(风险差异0%,95%CI -1% ~ 2%, I2 = 15%, p = 0.63)。肥胖与住院时间显著缩短相关(平均差值为2.92天,95%CI为-5.03至-0.80,I2 = 74%, p = 0.007),但对ECMO持续时间没有影响(平均差值为0.35天,95%CI为-0.03至0.74,I2 = 41%, p = 0.07)。总之,我们的荟萃分析显示,肥胖是V-V-ECMO的有利预后因素。然而,肥胖增加了V-A-ECMO患者的死亡率。在评估个体肥胖患者的ECMO候选性时,应考虑ECMO支持的方式。
Impact of obesity on outcomes in patients receiving extracorporeal membrane oxygenation: A systematic review and meta-analysis.
Given the growing obesity pandemic, the impact of obesity on outcomes of Extracorporeal Membrane Oxygenation (ECMO) would be increasingly relevant to our daily practise. This meta-analysis aims to evaluate the impact of obesity on ECMO outcomes, integrating the latest evidence. Systematic literature search was conducted from inception until December 2024 on MEDLINE, Embase and the Cochrane Library using the terms 'ECMO', 'obesity', and their related terms. Twenty-eight studies were included from 2013 to 2024, including a total of 74,330 ECMO patients (Mean age 52.84 ± 13.55 years). Obese patients had a similar risk of in-hospital or 30-day mortality when compared to non-obese patients (Risk difference -2%, 95%CI -5% to -1%, I2 = 85%, p = 0.25). Subgroup analysis of patients on V-V-ECMO showed a trend towards lower mortality in obese patients which did not reach statistical significance (risk difference -6%, 95%CI -13% to 0%, I2 = 53%, p = 0.06). Subgroup analysis of patients on V-A-ECMO showed significantly higher mortality in obese patients (risk difference 5%, 95%CI 1% to 9%, I2 = 54%, p = 0.007). Regarding secondary outcomes, obesity had no significant association with major bleeding or thrombotic complications (Risk difference 0%, 95%CI -1% to 2%, I2 = 15%, p = 0.63). Obesity was associated with significantly shorter hospital length-of-stay (Mean difference -2.92 days, 95% CI -5.03 to -0.80, I2 = 74%, p = 0.007), but had no impact on ECMO duration (Mean difference 0.35 days, 95%CI -0.03 to 0.74, I2 = 41%, p = 0.07). In summary, our meta-analysis showed that obesity was a favourable prognostic factor in V-V-ECMO. However, obesity increased mortality in V-A-ECMO patients. The modality of ECMO support should be taken into consideration when evaluating ECMO candidacy in individual obese patients.
期刊介绍:
The International Journal of Artificial Organs (IJAO) publishes peer-reviewed research and clinical, experimental and theoretical, contributions to the field of artificial, bioartificial and tissue-engineered organs. The mission of the IJAO is to foster the development and optimization of artificial, bioartificial and tissue-engineered organs, for implantation or use in procedures, to treat functional deficits of all human tissues and organs.