The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis
ObjectivePost-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a known rescue therapy for neonates and pediatric patients who failed to wean from cardiopulmonary bypass (CPB) or who deteriorate in intensive care unit (ICU) due to various reasons such as low cardiac output syndrome (LCOS),...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.869283/full |
| _version_ | 1818127364108845056 |
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| author | Hwa Jin Cho Hwa Jin Cho Insu Choi Yujin Kwak Do Wan Kim Do Wan Kim Reverien Habimana Reverien Habimana In-Seok Jeong In-Seok Jeong |
| author_facet | Hwa Jin Cho Hwa Jin Cho Insu Choi Yujin Kwak Do Wan Kim Do Wan Kim Reverien Habimana Reverien Habimana In-Seok Jeong In-Seok Jeong |
| author_sort | Hwa Jin Cho |
| collection | DOAJ |
| description | ObjectivePost-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a known rescue therapy for neonates and pediatric patients who failed to wean from cardiopulmonary bypass (CPB) or who deteriorate in intensive care unit (ICU) due to various reasons such as low cardiac output syndrome (LCOS), cardiac arrest and respiratory failure. We conducted a systematic review and meta-analysis to assess the survival in neonates and pediatric patients who require PC-ECMO and sought the difference in survivals by each indication for PC-ECMO.DesignSystematic review and meta-analysis.SettingMulti-institutional analysis.ParticipantsNeonates and pediatric patients who requires PC- ECMO.InterventionsECMO after open-heart surgery.ResultsTwenty-six studies were included in the analysis with a total of 186,648 patients and the proportion of the population who underwent PC-ECMO was 2.5% (2,683 patients). The overall pooled proportion of survival in this population was 43.3% [95% Confidence interval (CI): 41.3–45.3%; I2: 1%]. The survival by indications of PC-ECMO were 44.6% (95% CI: 42.6–46.6; I2: 0%) for CPB weaning failure, 47.3% (95% CI: 39.9–54.7%; I2: 5%) for LCOS, 37.6% (95% CI: 31.0–44.3%; I2: 32%) for cardiac arrest and 47.7% (95% CI: 32.5–63.1%; I2: 0%) for respiratory failure. Survival from PC-ECMO for single ventricle or biventricular physiology, was reported by 12 studies. The risk ratio (RR) was 0.74 for survival in patients with single ventricle physiology (95% CI: 0.63–0.86; I2: 40%, P < 0.001). Eight studies reported on the survival after PC-ECMO for genetic conditions. The RR was 0.93 for survival in patients with genetic condition (95% CI: 0.52–1.65; I2: 65%, P = 0.812).ConclusionsPC-ECMO is an effective modality to support neonates and pediatric patients in case of failed CPB weaning and deterioration in ICU. Even though ECMO seems to improve survival, mortality and morbidity remain high, especially in neonates and pediatric patients with single ventricle physiology. Most genetic conditions alone should not be considered a contraindication to ECMO support, further studies are needed to determine which genetic abnormalities are associated with favorable outcome. |
| first_indexed | 2024-12-11T07:16:11Z |
| format | Article |
| id | doaj.art-9d23075daa7a42a8ba49d45f20582600 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-11T07:16:11Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-9d23075daa7a42a8ba49d45f205826002022-12-22T01:16:13ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-04-011010.3389/fped.2022.869283869283The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-AnalysisHwa Jin Cho0Hwa Jin Cho1Insu Choi2Yujin Kwak3Do Wan Kim4Do Wan Kim5Reverien Habimana6Reverien Habimana7In-Seok Jeong8In-Seok Jeong9Division of Pediatric Cardiology and Cardiac Critical Care, Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, South KoreaCardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South KoreaDivision of Pediatric Cardiology and Cardiac Critical Care, Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, South KoreaDepartment of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South KoreaCardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South KoreaDepartment of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South KoreaCardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South KoreaDepartment of Biomedical Sciences, College of Medicine, Chonnam National University Graduate School, Gwangju, South KoreaCardiovascular and Respiratory Research Team, Chonnam National University Hospital, Gwangju, South KoreaDepartment of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju, South KoreaObjectivePost-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) is a known rescue therapy for neonates and pediatric patients who failed to wean from cardiopulmonary bypass (CPB) or who deteriorate in intensive care unit (ICU) due to various reasons such as low cardiac output syndrome (LCOS), cardiac arrest and respiratory failure. We conducted a systematic review and meta-analysis to assess the survival in neonates and pediatric patients who require PC-ECMO and sought the difference in survivals by each indication for PC-ECMO.DesignSystematic review and meta-analysis.SettingMulti-institutional analysis.ParticipantsNeonates and pediatric patients who requires PC- ECMO.InterventionsECMO after open-heart surgery.ResultsTwenty-six studies were included in the analysis with a total of 186,648 patients and the proportion of the population who underwent PC-ECMO was 2.5% (2,683 patients). The overall pooled proportion of survival in this population was 43.3% [95% Confidence interval (CI): 41.3–45.3%; I2: 1%]. The survival by indications of PC-ECMO were 44.6% (95% CI: 42.6–46.6; I2: 0%) for CPB weaning failure, 47.3% (95% CI: 39.9–54.7%; I2: 5%) for LCOS, 37.6% (95% CI: 31.0–44.3%; I2: 32%) for cardiac arrest and 47.7% (95% CI: 32.5–63.1%; I2: 0%) for respiratory failure. Survival from PC-ECMO for single ventricle or biventricular physiology, was reported by 12 studies. The risk ratio (RR) was 0.74 for survival in patients with single ventricle physiology (95% CI: 0.63–0.86; I2: 40%, P < 0.001). Eight studies reported on the survival after PC-ECMO for genetic conditions. The RR was 0.93 for survival in patients with genetic condition (95% CI: 0.52–1.65; I2: 65%, P = 0.812).ConclusionsPC-ECMO is an effective modality to support neonates and pediatric patients in case of failed CPB weaning and deterioration in ICU. Even though ECMO seems to improve survival, mortality and morbidity remain high, especially in neonates and pediatric patients with single ventricle physiology. Most genetic conditions alone should not be considered a contraindication to ECMO support, further studies are needed to determine which genetic abnormalities are associated with favorable outcome.https://www.frontiersin.org/articles/10.3389/fped.2022.869283/fullpost-cardiotomyextracorporeal membrane oxygenationcardiac surgeryneonatespediatric |
| spellingShingle | Hwa Jin Cho Hwa Jin Cho Insu Choi Yujin Kwak Do Wan Kim Do Wan Kim Reverien Habimana Reverien Habimana In-Seok Jeong In-Seok Jeong The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis Frontiers in Pediatrics post-cardiotomy extracorporeal membrane oxygenation cardiac surgery neonates pediatric |
| title | The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis |
| title_full | The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis |
| title_fullStr | The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis |
| title_short | The Outcome of Post-cardiotomy Extracorporeal Membrane Oxygenation in Neonates and Pediatric Patients: A Systematic Review and Meta-Analysis |
| title_sort | outcome of post cardiotomy extracorporeal membrane oxygenation in neonates and pediatric patients a systematic review and meta analysis |
| topic | post-cardiotomy extracorporeal membrane oxygenation cardiac surgery neonates pediatric |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.869283/full |
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