Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis
Abstract Background In the last decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been gaining in popularity for intraoperative support during lung transplant (LT), being advocated for routinely use also in uncomplicated cases. Compared to off-pump strategy and, secondarily,...
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2024-12-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
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| Online Access: | https://doi.org/10.1186/s44158-024-00214-x |
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| author | Tommaso Pettenuzzo Honoria Ocagli Nicolò Sella Alessandro De Cassai Francesco Zarantonello Sabrina Congedi Maria Vittoria Chiaruttini Elisa Pistollato Marco Nardelli Martina Biscaro Mara Bassi Giordana Coniglio Eleonora Faccioli Federico Rea Dario Gregori Paolo Navalesi Annalisa Boscolo the PADOVA ICU Group |
| author_facet | Tommaso Pettenuzzo Honoria Ocagli Nicolò Sella Alessandro De Cassai Francesco Zarantonello Sabrina Congedi Maria Vittoria Chiaruttini Elisa Pistollato Marco Nardelli Martina Biscaro Mara Bassi Giordana Coniglio Eleonora Faccioli Federico Rea Dario Gregori Paolo Navalesi Annalisa Boscolo the PADOVA ICU Group |
| author_sort | Tommaso Pettenuzzo |
| collection | DOAJ |
| description | Abstract Background In the last decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been gaining in popularity for intraoperative support during lung transplant (LT), being advocated for routinely use also in uncomplicated cases. Compared to off-pump strategy and, secondarily, to traditional cardiopulmonary bypass (CPB), V-A ECMO seems to offer a better hemodynamic stability and oxygenation, while data regarding blood product transfusions, postoperative recovery, and mortality remain unclear. This systematic review and network meta-analysis aims to evaluate the comparative efficacy and safety of V-A ECMO and CPB as compared to OffPump strategy during LT. Methods A comprehensive literature search was conducted across multiple databases (PubMed Embase, Cochrane, Scopus) and was updated in February 2024. A Bayesian network meta-analysis (NMA), with a fixed-effect approach, was performed to compare outcomes, such as intraoperative needing of blood products, invasive mechanical ventilation (IMV) duration, intensive care unit (ICU) length of stay (LOS), surgical duration, needing of postoperative ECMO, and mortality, across different supports (i.e., intraoperative V-A (default (d) or rescue (r)) ECMO, CPB, or OffPump). Findings Twenty-seven observational studies (6113 patients) were included. As compared to OffPump surgery, V-A ECMOd, V-A ECMOr, and CPB recorded a higher consumption of all blood products, longer IMV durations, prolonged ICU LOS, surgical duration, and higher mortalities. Comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. The lowest rate of postoperative ECMO was recorded after OffPump surgery, while no differences were found comparing different extracorporeal supports. Finally, older age, male gender, and body mass index ≥ 25 kg/m2 negatively impacted on RBC transfusions, ICU LOS, surgical duration, need of postoperative ECMO, and mortality, regardless of the intraoperative extracorporeal support investigated. Interpretation This comparative network meta-analysis highlights that OffPump overperformed ECMO and CPB in all outcomes of interest, while, comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. Older age, male gender, and higher BMI negatively affect several outcomes across different intraoperative strategies, regardless of the intraoperative extracorporeal support investigated. Future prospective studies are necessary to optimize and standardize the intraoperative management of LT. |
| format | Article |
| id | doaj-art-05125e34eb3e4c25809b2fb492f3b1db |
| institution | Kabale University |
| issn | 2731-3786 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj-art-05125e34eb3e4c25809b2fb492f3b1db2024-12-22T12:55:02ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862024-12-014111810.1186/s44158-024-00214-xIntraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysisTommaso Pettenuzzo0Honoria Ocagli1Nicolò Sella2Alessandro De Cassai3Francesco Zarantonello4Sabrina Congedi5Maria Vittoria Chiaruttini6Elisa Pistollato7Marco Nardelli8Martina Biscaro9Mara Bassi10Giordana Coniglio11Eleonora Faccioli12Federico Rea13Dario Gregori14Paolo Navalesi15Annalisa Boscolo16the PADOVA ICU GroupInstitute of Anaesthesia and Intensive Care, Padua University HospitalUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of PaduaInstitute of Anaesthesia and Intensive Care, Padua University HospitalInstitute of Anaesthesia and Intensive Care, Padua University HospitalInstitute of Anaesthesia and Intensive Care, Padua University HospitalDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of PaduaUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of PaduaDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of PaduaDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of PaduaDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of PaduaDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of PaduaDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of PaduaDepartment of Cardiac, Thoracic, Vascular Sciences and Public Health, University of PaduaDepartment of Cardiac, Thoracic, Vascular Sciences and Public Health, University of PaduaUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of PaduaInstitute of Anaesthesia and Intensive Care, Padua University HospitalInstitute of Anaesthesia and Intensive Care, Padua University HospitalAbstract Background In the last decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been gaining in popularity for intraoperative support during lung transplant (LT), being advocated for routinely use also in uncomplicated cases. Compared to off-pump strategy and, secondarily, to traditional cardiopulmonary bypass (CPB), V-A ECMO seems to offer a better hemodynamic stability and oxygenation, while data regarding blood product transfusions, postoperative recovery, and mortality remain unclear. This systematic review and network meta-analysis aims to evaluate the comparative efficacy and safety of V-A ECMO and CPB as compared to OffPump strategy during LT. Methods A comprehensive literature search was conducted across multiple databases (PubMed Embase, Cochrane, Scopus) and was updated in February 2024. A Bayesian network meta-analysis (NMA), with a fixed-effect approach, was performed to compare outcomes, such as intraoperative needing of blood products, invasive mechanical ventilation (IMV) duration, intensive care unit (ICU) length of stay (LOS), surgical duration, needing of postoperative ECMO, and mortality, across different supports (i.e., intraoperative V-A (default (d) or rescue (r)) ECMO, CPB, or OffPump). Findings Twenty-seven observational studies (6113 patients) were included. As compared to OffPump surgery, V-A ECMOd, V-A ECMOr, and CPB recorded a higher consumption of all blood products, longer IMV durations, prolonged ICU LOS, surgical duration, and higher mortalities. Comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. The lowest rate of postoperative ECMO was recorded after OffPump surgery, while no differences were found comparing different extracorporeal supports. Finally, older age, male gender, and body mass index ≥ 25 kg/m2 negatively impacted on RBC transfusions, ICU LOS, surgical duration, need of postoperative ECMO, and mortality, regardless of the intraoperative extracorporeal support investigated. Interpretation This comparative network meta-analysis highlights that OffPump overperformed ECMO and CPB in all outcomes of interest, while, comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. Older age, male gender, and higher BMI negatively affect several outcomes across different intraoperative strategies, regardless of the intraoperative extracorporeal support investigated. Future prospective studies are necessary to optimize and standardize the intraoperative management of LT.https://doi.org/10.1186/s44158-024-00214-xLung transplantTransplantationECMOExtracorporeal membrane oxygenationCPBCardiopulmonary bypass |
| spellingShingle | Tommaso Pettenuzzo Honoria Ocagli Nicolò Sella Alessandro De Cassai Francesco Zarantonello Sabrina Congedi Maria Vittoria Chiaruttini Elisa Pistollato Marco Nardelli Martina Biscaro Mara Bassi Giordana Coniglio Eleonora Faccioli Federico Rea Dario Gregori Paolo Navalesi Annalisa Boscolo the PADOVA ICU Group Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis Journal of Anesthesia, Analgesia and Critical Care Lung transplant Transplantation ECMO Extracorporeal membrane oxygenation CPB Cardiopulmonary bypass |
| title | Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis |
| title_full | Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis |
| title_fullStr | Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis |
| title_full_unstemmed | Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis |
| title_short | Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis |
| title_sort | intraoperative extracorporeal support for lung transplant a systematic review and network meta analysis |
| topic | Lung transplant Transplantation ECMO Extracorporeal membrane oxygenation CPB Cardiopulmonary bypass |
| url | https://doi.org/10.1186/s44158-024-00214-x |
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