Clinical Outcomes of Adult Patients Who Receive Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the clinical outcomes of adult patients receiving extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiogenic shock (PCS).

DESIGN: Meta-analysis of 20 observational studies.

SETTING: Hospitals that perform cardiac surgery.

PARTICIPANTS: The study included 2,877 PCS patients undergoing ECMO from 20 observational studies.

INTERVENTIONS: ECMO use.

MEASUREMENTS AND MAIN RESULTS: Twenty observational studies were selected for final analysis. The pooled survival rate to hospital discharge was 34.0% (30.0%-38.0%) in PCS patients receiving ECMO. The pooled 1-year survival rate was 24.0% (19.05%-30.0%). The pooled midterm survival rate was 18.0% (11.0%-27.0%). The pooled rate of leg ischemia was 14.0% (10.0%-20.0%). The pooled rate of redo surgery was 50.0% (32.0%-68.0%). The pooled rate of renal failure was 57.0% (47.0%-66.0%). The pooled rate of neurologic complications was 16.0% (13.0%-20.0%). The pooled rate of infection was 31.0% (22.0%-41.0%). Most of the included studies commonly revealed that age >65 years, pre-ECMO or post-ECMO blood lactate, renal insufficiency, a longer duration of ECMO, and neurologic complications were risk factors of in-hospital mortality in PCS patients undergoing ECMO.

CONCLUSIONS: The short-term and midterm survival rates of PCS patients treated with ECMO were disappointingly low, and post-ECMO complication rates were relatively high.