Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: a meta-analysis

Magouliotis, Dimitrios; Tasiopoulou, Vasiliki S.; Svokos, Alexis; Svokos, Konstantina; Zacharoulis, Dimitris

doi:10.1007/s11748-017-0836-3

Cited by 86 publications

(71 citation statements)

References 23 publications

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“…Furthermore, poorly controlled hemodynamics during lung transplant surgery can result in intraoperative hypotension, one of the most significant risk factors for the development of AKI after lung transplantation [10,24]. Currently, CPB remains a standard method used in lung transplantation for intraoperative cardiorespiratory support, especially in cases of poor hemodynamic tolerance or severe pulmonary arterial hypertension [63]. However, CPB is commonly associated with inflammatory reactions and bleeding complications [64].…”

Section: Discussionmentioning

confidence: 99%

“…However, CPB is commonly associated with inflammatory reactions and bleeding complications [64]. ECMO has more recently been used as an alternative option to CPB for intraoperative cardiopulmonary support during lung transplantation [63]. When compared to CPB, studies have demonstrated beneficial effects of intraoperative ECMO support, with lower rates of primary graft dysfunction, acute post-operative bleeding, AKI requiring RRT, and length of hospital stay [63].…”

Section: Discussionmentioning

confidence: 99%

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Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Lertjitbanjong

Cheungpasitporn

O'Corragain

et al. 2019

JCM

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Background: Lung transplantation has been increasingly performed worldwide and is considered an effective therapy for patients with various causes of end-stage lung diseases. We performed a systematic review to assess the incidence and impact of acute kidney injury (AKI) and severe AKI requiring renal replacement therapy (RRT) in patients after lung transplantation. Methods: A literature search was conducted utilizing Ovid MEDLINE, EMBASE, and Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring RRT, and mortality risk of AKI among patients after lung transplantation. Pooled incidence and odds ratios (ORs) with 95% confidence interval (CI) were obtained using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019134095). Results: A total of 26 cohort studies with a total of 40,592 patients after lung transplantation were enrolled. Overall, the pooled estimated incidence rates of AKI (by standard AKI definitions) and severe AKI requiring RRT following lung transplantation were 52.5% (95% CI: 45.8–59.1%) and 9.3% (95% CI: 7.6–11.4%). Meta-regression analysis demonstrated that the year of study did not significantly affect the incidence of AKI (p = 0.22) and severe AKI requiring RRT (p = 0.68). The pooled ORs of in-hospital mortality in patients after lung transplantation with AKI and severe AKI requiring RRT were 2.75 (95% CI, 1.18–6.41) and 10.89 (95% CI, 5.03–23.58). At five years, the pooled ORs of mortality among patients after lung transplantation with AKI and severe AKI requiring RRT were 1.47 (95% CI, 1.11–1.94) and 4.79 (95% CI, 3.58–6.40), respectively. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring RRT in patients after lung transplantation are 52.5% and 9.3%, respectively. Despite advances in therapy, the incidence of AKI in patients after lung transplantation does not seem to have decreased. In addition, AKI after lung transplantation is significantly associated with reduced short-term and long-term survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Lertjitbanjong

Cheungpasitporn

O'Corragain

et al. 2019

JCM

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“…In addition, use of ECMO rather than cardiopulmonary bypass might also have contributed to a lower incidence of bleeding. Lung transplantation using cardiopulmonary bypass has been associated with an increased risk of bleeding when compared to ECMO .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

et al. 2019

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Risk factors for early bleeding complications after lung transplantation are not well described. Our aim was to evaluate coagulation test results and the use of extracorporeal membrane oxygenation as risk factors for bleeding after lung transplantation. We analyzed a single-center cohort of bilateral lung transplants between January 2009 and August 2015. Predictors of severe postoperative bleeding (bleeding requiring reoperation within 48 h of transplantation) were assessed using multivariable logistic regression. The effect of bleeding on survival was assessed using a Cox proportionalhazards model. Twenty-nine (4.5%) of 641 patients experienced severe postoperative bleeding. Postoperative fibrinogen levels (OR = 0.99, 95% CI 0.98-0.995, P = 0.001; per mg/dl increase) and pre-and postoperative use of extracorporeal membrane oxygenation (OR = 14.41% 95% CI 5.4-40.19, P < 0.001 and OR = 4.25, 95% CI 1.0-11.09, P = 0.002, respectively) were associated with an increased risk of severe postoperative bleeding. Severe postoperative bleeding was associated with decreased survival within 60 days after transplantation (adjusted HR = 5.73, 95% CI 2.52-13.02, P < 0.001). Low postoperative fibrinogen levels, and pre-and postoperative use of extracorporeal membrane oxygenation were risk factors for bleeding after lung transplantation.

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“…All relevant articles were evaluated using the following selection and exclusion criteria: published in English from 1975 to 2018, inclusively; survival analysis stratified by ECMO status; an HR with a 95% confidence interval (CI) or sufficient data for estimating them [12]; case-controlled, retrospective, prospective, or randomly controlled in design, with its basic demographic information; and equal to or exceeding total 10 human adult subjects [13,14]. If more than one study was based on the overlapping population, only the most recently published study was included in the analysis.…”

Section: El I Gi Bi L I Ty Cri Te Ri a El I Gi Bi L I Ty Cri Te Ri Amentioning

confidence: 99%

Extracorporeal membrane oxygenation meta-analysis of time-to-event data in respiratory failure in adults v1

Roh¹

2020

Preprint

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Time-to-event data of hazard ratios were used to generate a forest plot of mortality on extracorporeal membrane oxygenation (ECMO) in respiratory failure in adults. Ma te ri a l s a nd Me thods: Ma te ri a l s a nd Me thods: A systemic search was conducted in PubMed from 1975 to 2018. Among 4,121 articles, a total of 5 clinical reports comprising 1,014patients (333 of the patients who underwent ECMO and 681 of the patients who did not undergo ECMO) met the inclusion criteria. Re sul ts: Re sul ts: The pooled hazard ratio of 0.64 (95% confidence interval (CI): 0.54, 0.76) suggests that the ECMO group comprising both veno-arterial (VA) type and a majority of veno-venous (VV) type was significantly associated with a reduction in mortality compared with the non-ECMO group in respiratory failure. The results of VV-ECMO alone also showed significantly improved patient survival of respiratory failure with the hazard ratio of 0.67 (0.56, 0.81). Concl usi ons: Concl usi ons: The results of the ECMO group with VV and VA types, or the VV type alone revealed a reduction in mortality for patients with respiratory failure based on time-to-event data.Future investigation of the efficacy of VA-ECMO alone in respiratory failure may be more enlightening.

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Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: a meta-analysis

Abstract: The present study indicates that the intraoperative use of ECMO is associated with increased efficacy and safety, regarding short-term outcomes, compared to CPB. Well-designed, randomized studies, comparing ECMO to CPB, are necessary to assess their clinical outcomes further.

Cited by 86 publications

References 23 publications

Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

Extracorporeal membrane oxygenation meta-analysis of time-to-event data in respiratory failure in adults v1

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