ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
-
Meta Analysis
Del Nido Cardioplegia for Myocardial Protection in Adult Cardiac Surgery: A Systematic Review and Meta-Analysis.
Cardioplegia is an important strategy for myocardial protection during cardiac surgery. This meta-analysis was to compare the effects of del Nido and conventional cardioplegia in adult patients. Systematic searches were performed to identify studies using PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform. ⋯ Ventilation time and length of intensive care unit were decreased significantly with del Nido cardioplegia (MD: -1.05, 95% CI: -1.79 to -0.31, p = 0.006; MD: -0.65, 95% CI: -0.92 to -0.38, p < 0.00001). There were no differences in myocardial enzyme, postoperative inotropic support, atrial fibrillation, hospital, and mortality between the two groups. In adult cardiac surgery, myocardial protection used with the del Nido or conventional cardioplegia solution yield similar short-term clinical outcomes.
-
Extracorporeal circulation (ECC) is an invaluable tool in lung transplantation (lutx). More than the past years, an increasing number of centers changed their standard for intraoperative ECC from cardiopulmonary bypass (CPB) to extracorporeal membrane oxygenation (ECMO) - with differing results. This meta-analysis reviews the existing evidence. ⋯ These data indicate a benefit of the intraoperative use of ECMO as compared with CPB during lung transplant procedures regarding short-term outcome (ICU stay). There was no statistically significant effect regarding blood transfusion needs or long-term outcome. The superiority of ECMO in lutx patients remains to be determined in larger multi-center randomized trials.
-
The aim of the study was to systematically evaluate effect of CentriMag heart pump (Thoratec Corporation) as temporary ventricular assist device (VAD) and part of extracorporeal membrane oxygenation (ECMO) system on outcomes in patients with cardiac or cardiac-respiratory failure. A systematic search was conducted in five databases for the period 2003 to 2012. Fifty-three publications with data for 999 patients, supported with CentriMag, were included. ⋯ Mean duration of VAD support was 25.0 days in precardiotomy group, 10.9 days in postcardiac surgery cardiogenic shock group, 8.8 days in post-transplant graft failure and rejection group, and 16.0 days in post-LVAD placement right ventricular failure group. Survival on support was 82% (95% CI 70-92) for VAD support in precardiotomy cardiogenic shock indication, 63% (95% CI 46-78) in VAD support in postcardiac surgery cardiogenic shock indication, 62% (95% CI 46-76) in VAD support in post-transplant graft rejection or failure indication, and 83% (95% CI 73-92) in VAD support in post-LVAD placement right ventricular failure indication. CentriMag is an effective technology for temporary support of patients with cardiac and cardiorespiratory failure.
-
Meta Analysis
Molecular adsorbent recirculating system as artificial support therapy for liver failure: a meta-analysis.
Molecular Adsorbent Recirculating System (MARS) is an artificial liver support system that has been developed for patients with liver failure until the liver regains function or as a bridge to transplantation. We conducted a meta-analysis to examine the efficacy of this promising therapy. We searched MEDLINE, EMBASE, and the Cochrane Registry of Controlled Trials databases, and abstracts from the proceedings of several scientific meetings. ⋯ The limitations of this study include a small sample size, an inability to blind with significant heterogeneity among studies, and variable definitions of liver failure. The Molecular Adsorbent Recirculating System is associated with a significant improvement in total bilirubin levels and hepatic encephalopathy but has no impact on survival. Large studies are required to assess the merit of this promising therapy on patient-centered outcomes.
-
Meta Analysis Comparative Study
How minimalized extracorporeal circulation compares with the off-pump technique in coronary artery bypass grafting.
Recognition of the adverse effects of conventional extracorporeal circulation (CECC) led to the development of alternative technologies and techniques to minimize their impact while maintaining circulation during coronary artery bypass grafting (CABG). Off-pump coronary artery bypass (OPCAB) grafting has become established as one such alternative and more recently minimalized extracorporeal circulation (MECC) circuits have been developed with the aim of providing circulatory support while minimizing the interface between blood and the foreign surfaces of the circuit that initiates the associated adverse effects of CECC. Recently, some authors have suggested that MECC may be an alternative to OPCAB in patients undergoing CABG; the aim of this article is to systematically analyze and compare the impact of CABG with MECC with that of OPCAB, studying the adverse outcomes related to CECC. ⋯ We found no statistically significant difference in hospital or intensive care unit (ICU) LOS, blood loss, mean number of patients transfused, neurocognitive disturbance, or 30-day mortality between the two groups but a trend toward an increased number of cerebrovascular events in the MECC group was observed. The number of studies comparing these alternative techniques for coronary revascularization is small, and there is a lack of high-quality data. Currently, there seems little difference between MECC and OPCAB but larger randomized controlled trials focusing on high-risk patients are required.