Mortality Trends of Oncology and Hematopoietic Stem Cell Transplant Patients Supported on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.

Autor:	Pravin RR; Department of Pediatrics, KK Women's & Children's Hospital, Singapore.; Yong-Loo Lin School of Medicine, National University of Singapore, Singapore., Huang BX; Duke-NUS Medical School, Singapore., Sultana R; Center for Quantitative Medicine, Duke-NUS Medical School, Singapore., Tan CW; Duke-NUS Medical School, Singapore.; Department of Hematology, Singapore General Hospital, Singapore., Goh KJ; Duke-NUS Medical School, Singapore.; Department of Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore., Chan MY; Duke-NUS Medical School, Singapore.; Pediatric Hematology/Oncology Service, Department of Pediatric Subspecialties, KK Women's & Children's Hospital, Singapore., Ng HJ; Duke-NUS Medical School, Singapore.; Department of Hematology, Singapore General Hospital, Singapore., Phua GC; Duke-NUS Medical School, Singapore.; Department of Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore., Lee JH; Duke-NUS Medical School, Singapore.; Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's & Children's Hospital, Singapore., Wong JJ; Duke-NUS Medical School, Singapore.; Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's & Children's Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2022 Apr; Vol. 37 (4), pp. 555-564. Date of Electronic Publication: 2021 Aug 16.
DOI:	10.1177/08850666211021561
Abstrakt:	Background: There is an increasing frequency of oncology and hematopoietic stem cell transplant (HSCT) patients seen in the intensive care unit and requiring extracorporeal membrane oxygenation (ECMO), however, prognosis of this population over time is unclear. Methods: MEDLINE, EMBASE, Cochrane and Web of Science were searched from earliest publication until April 10, 2020 for studies to determine the mortality trend over time in oncology and HSCT patients requiring ECMO. Primary outcome was hospital mortality. Random-effects meta-analysis model was used to obtain pooled estimates of mortality and 95% confidence intervals. A priori subgroup metanalysis compared adult versus pediatric, oncology versus HSCT, hematological malignancy versus solid tumor, allogeneic versus autologous HSCT, and veno-arterial versus veno-venous ECMO populations. Multivariable meta-regression was also performed for hospital mortality to account for year of study and HSCT population. Results: 17 eligible observational studies (n = 1109 patients) were included. Overall pooled hospital mortality was 72% (95% CI: 65, 78). In the subgroup analysis, only HSCT was associated with a higher hospital mortality compared to oncology subgroup [84% (95% CI: 70, 93) vs. 66% (95% CI: 56, 74); P = 0.021]. Meta-regression showed that HSCT was associated with increased mortality [adjusted odds ratio (aOR) 3.84 (95% CI 1.77, 8.31)], however, mortality improved with time [aOR 0.92 (95% CI: 0.85, 0.99) with each advancing year]. Conclusion: This study reports a high overall hospital mortality in oncology and HSCT patients on ECMO which improved over time. The presence of HSCT portends almost a 4-fold increased risk of mortality and this finding may need to be taken into consideration during patient selection for ECMO.
Databáze:	MEDLINE
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