title: Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on survival and complication rates in adults with refractory cardiogenic shock or cardiac arrest.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  One thousand one hundred ninety-nine patients from 22 observational studies.
  
  
  METHODS
  None.
  
  
  RESULTS
  Observational studies published from the year 2000 onwards, examining at least 10 adult patients who received ECMO for refractory cardiogenic shock or cardiac arrest were included. Pooled estimates with 95% confidence intervals were calculated based on the Freeman-Tukey double-arcsine transformation and DerSimonian-Laird random-effect model. Survival to discharge was 40.2% (95% confidence intervals [CI], 33.9-46.7), while survival at 3, 6, and 12 months was 55.9% (95% CI, 41.5-69.8), 47.6% (95% CI, 25.4-70.2), and 54.4% (95% CI, 36.6-71.7), respectively. Survival up to 30 days was higher in cardiogenic shock patients (52.5%, 95% CI, 43.7%-61.2%) compared to cardiac arrest (36.2%, 95% CI, 23.1%-50.4%). Concurrently, complication rates were particularly substantial for neurologic deficits (13.3%, 95% CI, 8.3-19.3), infection (25.1%, 95%CI, 15.9-35.5), and renal impairment (47.4%, 95% CI, 30.2-64.9). Significant heterogeneity was detected, although its levels were similar to previous meta-analyses that only examined short-term survival to discharge.
  
  
  CONCLUSIONS
  Venoarterial ECMO can improve short-term survival in adults with refractory cardiogenic shock or cardiac arrest. It also may provide favorable long-term survival at up to 3 years postdischarge. However, ECMO also is associated with significant complication rates, which must be incorporated into the risk-benefit analysis when considering treatment. These findings require confirmation by large, adequately controlled and standardized trials with long-term follow-up.
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Xie
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Department of Cardiothoracic Surgery, Prince Charles Hospital, Brisbane, Australia.
authors.forename: Yi-Chin
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery; University of Sydney, Sydney, Australia. Electronic address: tristanyan@annalscts.com.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.affiliation: Cardiothoracic Anesthesia and Perfusion, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Forrest
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D064887:Observational Studies as Topic / Q000379:methods; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: adult; cardiac arrest; cardiogenic shock; extracorporeal circulation; extracorporeal membrane oxygenation; meta-analysis