Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women: A Systematic Review and Meta-Regression Analysis

Abstract

Background: Although extracorporeal membrane oxygenation (ECMO) is frequently utilized as a salvage therapy for patients with cardiopulmonary failure, outcomes of its use in peripartum patients have not been clearly established. We aimed to review peer-reviewed publications on the use of ECMO in pregnant and postpartum patients, with analyses of maternal and fetal outcomes. Methods: Data were retrieved from MEDLINE, EMBASE, and Scopus databases from 1972 up to November 2017 for publications on ECMO in peripartum patients. Search terms included “ECMO,” “ECLS,”, “pregnancy,” “postpartum,” and “peripartum.” Publications with 3 or more patients were reviewed for quality using the Joanna Briggs Institute checklist for prevalence studies and case series. Results: After reviewing 143 publications, 9 observational studies met our inclusion criteria. Pooled prevalence of maternal survival was 77.2% (95% confidence interval [CI]: 64.1%-88.4%). Pooled prevalence of fetal survival was 69.1% (95% CI: 44.7%-89.8%). The level of heterogeneity across studies was low for both outcomes. Meta-regression did not reveal any correlation between pregnant women with pulmonary or cardiac indications and maternal survival. Individual patient data meta-regression demonstrated higher odds of survival for patients on venovenous ECMO compared to those on venoarterial ECMO that was close to statistical significance (odds ratio = 3.016, 95% CI: 0.901-11.144; P = .081) after adjusting for pregnancy status. Conclusions: Extracorporeal membrane oxygenation can be considered as an acceptable salvage therapy for pregnant and postpartum patients with critical cardiac or pulmonary illness.

Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

“…were included in our meta-analysis. Case reports and series with a sample size of <5 were excluded per recommendations by the Cochrane Statistical Methods Group and in accordance with methodologies of previously published meta-analyses [7][8][9]. Other exclusion Table 2].…”

Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

“…As a high degree of inter-study heterogeneity was expected, random effects meta-analyses (DerSimonian and Laird) [ 18 , 19 ] were conducted on R 3.6.1 using the meta (v4.12-0) and dmetar (v0.0.9000) packages, and confidence intervals (CI) were computed using the Clopper–Pearson method [ 20 ]. Mortality outcomes are presented as pooled proportions and 95% confidence intervals (CI), and dichotomous outcomes are presented as odds ratios (ORs) and 95% CI.…”

“…Planned subgroup analyses were conducted with continuity correction to allow the inclusion of studies with zero events and included the other reported mortalities (in-hospital, ICU, 30-day or 90-day), the geographical location (Asia, Europe, America, and Australia), the presence of renal replacement therapy (RRT and no RRT), the duration ECMO (more and less than 7 days) and the year of publication (before and after 2016). Summary-level meta-regression was conducted if a minimum of 6 data points could be collected to explore potential sources of heterogeneity or prognostically-relevant study-level covariates [ 18 ]. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidance to assess between-study heterogeneity and rated the certainty of evidence using the GRADE approach [ 21 , 22 , 23 ].…”

Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis

“…A minimum sample size of 4 was implemented in accordance with the methodologies of previously published meta-analyses. 21 , 22 The quality of included studies was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series.…”