Effect of extracorporeal membrane oxygenation on critical patients with non-pulmonary primary disease in the emergency department: a meta-analysis

Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) on critical patients with non-pulmonary primary disease in the emergency department. Methods The literature of English and Chinese clinical studies on the ECMO treating critical patients with non-pulmonary primary disease published before August 2017 were electronically searched on PubMed, Embase and other databases. The obtained articles were selected, their qualities were strictly evaluated, and the in-hospital survival rate, 3-month, 6-month and 1-year survival rate, as well as the average intensive care unit (ICU) and length of hospital stay were extracted. This meta-analysis were performed using RevMan software (Version 5.0, Cochrane collaboration). Results A total of 11 articles (n=3 043) were enrolled including 616 cases of ECMO treatment group and 2 427 cases of control group. Fitting results showed that compared with the traditional treatment, application of ECMO can improve the in-hospital survival rate[52.1%(321/616) vs. 32.1% (780/2 427); OR=2.02; 95%CI:1.11-3.67, P=0.02] and the survival rate more than 90 days[42.1% (61/145) vs. 17.1% (38/222); OR=3.98; 95%CI:2.30-6.89, P<0.01]; and prolong the average length of hospital stay (MD=-5.35, 95%CI:-8.10--2.60, P<0.01) and ICU time (MD=-8.99, 95%CI:-8.20--1.80, P<0.01). Conclusions Meta-analysis of existing studies showed that application of ECMO can improve the short-term and long-term prognosis of critical patients with non-pulmonary primary disease. However, due to the small number of studies and the large heterogeneity of the study population, it is necessary to carry out more, large samples and high quality randomized controlled clinical trials. Key words: Extracorporeal membrane oxygenation; Poisoning; Cardiac arrest; Arrhythmia; Emergency critical disease; Meta analysis