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Venous-arterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest. The exact complication rate is not well understood, in part due to small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining complication rates for ECMO.
A systematic MEDLINE search was conducted on ECMO for treatment of cardiac shock or cardiac arrest, updated up to July 2012. Studies with N>30 published in the year 2000 or later, which reported complication rates for ECMO were included. Specific complications analyzed included lower extremity ischemia, fasciotomy, amputation, bleed, stroke, neurologic sequelae, acute kidney injury, systemic infection, and rethoracotomy for bleeding or tamponade. For studies that included overlapping patients, the largest study was included and the others excluded. Cochran's Q and I2 were calculated. A conservative random effects model was chosen for all analyses.
26 studies were included in the analyses encompassing 277-1,320 patients depending on the specific complication analyzed. Results are summarized in Table 1.
While ECMO could improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention. These findings could be incorporated in the risk benefit analysis when initiation of ECMO for cardiogenic shock is being considered.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Lessons Learned from Acute Decompensated Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1175-289
- 2013 American College of Cardiology Foundation