ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Meta Analysis
Use of extracorporeal membrane oxygenation for adults in cardiac arrest (E-CPR): a meta-analysis of observational studies.
Published data on the use of extracorporeal membrane oxygenation (ECMO) as a supportive measure during or immediately after cardiopulmonary resuscitation (CPR) in adults (older than 18 years) shows mixed results. To assess the clinical outcomes of the use of ECMO in this modality and to look for predictors of mortality, we performed a meta-analysis (MA) of individual patients collected from observational studies. An electronic PubMed search restricted to English-language publications between 1990 and 2007, using a consensus restrictive criterion, retrieved 141 titles. ⋯ There was a negative trend in survival when manual CPR lasted >30 minutes without prompt ECMO initiation (OR 1.9; 95% CL, 0.9-4.2). This work confirms the expectations for a better survival when E-CPR is used in younger patients, for shorter periods of time and after expeditious implementation during or immediately after manual CPR. Neurologic sequelae and other major complications, although suspected to be high, are poorly described in the reviewed literature.
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Meta Analysis
Systemic leukofiltration does not attenuate pulmonary injury after cardiopulmonary bypass.
Pulmonary injury mediated by activated leukocytes is a recognized complication of cardiopulmonary bypass. The aim of this paper is to systematically analyze the effects of systemic leukofiltration within the cardiopulmonary bypass circuit on pulmonary injury and related clinical outcomes. We performed a systematic search to identify randomized controlled trials reporting on the effects of systemic leukofiltration on respiratory parameters. ⋯ Leukofiltration significantly reduced the duration of ventilatory support postoperatively (WMD, -2.11 hours; 95% CI, -0.65 to -3.58; p = 0.005), but had no impact on postoperative chest infection, intensive care length of stay or hospital length of stay. The heterogeneity of the included studies was high, due to poor quality study design and failure to include patients at high risk of pulmonary complications. Systemic leukofiltration may attenuate bypass-related lung injury in the early postoperative period, but this does not seem to translate to clinically significant differences in outcomes.