Table 1.
Summary of included studies.
| Author/Year (Reference) | Location | Study Period Start and End Year | N | ECMO Type (VA/VV/Not Spec) |
ECMO Days (Mean +/−SD) | Transfusion Trigger (g/dL or HCt %) | % Not Transfused PRBC on ECMO | PRBC/Day (Mean +/−SD) | Survival to Discharge (%) | Study Type | Brief Description |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Anselmi 2016 [9] | France | 2005–2014 | 30 | 27/3/0 | 8.9 (+/−7.3) | 24% | 0.0% | 2.97 (+/−1.63) | 50.0% | R. obs | Mixed—cardiogenic shock after heart transplant (47%) or cardiotomy (40%) and small number of respiratory failures—cohort report on use of recombinant factor VIIa |
| Buscher 2016 [10] | Australia | 2009–2010 | 48 | 32/16/0 | 8.0 (+/−7.0) | 8 g/dl | 8.3% | 1.57 (+/−1.79) | 69.0% | R. obs | Mixed—cardiogenic shock of all causes, including eCPR and severe respiratory failure (mostly ARDS but 3 post-transplant) |
| Czobor 2016 [11] | USA | 2012–2014 | 25 | 25/0/0 | NR | 8.0% | 40.0% | R. obs | Nonsurgical—cardiogenic shock and eCPR—cohort report on predictive utility of SOFA score | ||
| Hryniewicz 2016 [12] | USA | 2012–2013 | 37 | 37/0/0 | 4.7 (+/−2.3) | 8.1% | 2.52 (+/−1.61) | 64.9% | R. obs | Mixed cardiogenic shock post-AMI (18), cardiotomy (5), decompensated failure (6) | |
| Krueger 2016 [13] | Germany | 2011–2015 | 61 | 0/61/0 | 12.0 (+/−6.5) | 10 g/dL | 1.15 (+/−1.35) | R. obs | Nonsurgical—respiratory failure, principally ARDS—cohort review for outcomes of anticoagulation with VTE prophylaxis only in VV ECMO patients | ||
| Mazzeffi 2016 [14] | USA | 2010–2013 | 132 | 68/54/0 | 8.0 (+/−6.7) | 2.42 (+/−1.97) | 50.8% | R. obs | Mixed—cardiogenic shock, mostly postcardiotomy (38) and ARDS (54)—cohort review for predictors of bleeding events | ||
| Opfermann 2016 [15] | Austria | 2001–2014 | 300 | 300/0/0 | 6.1 (+/−4.8) | 0.74 (+/−0.79) | 51.7% | R. obs | Surgical—cardiogenic shock postcardiotomy—cohort review for predictors of survival | ||
| Pan 2016 [16] | Australia | 2010–2014 | 184 | 128/56/0 | 7.0 (+/−4.9) | 1.30 (+/−1.33) | 73.4% | R. obs | Mixed—cardiogenic shock of varying causes, including postcardiotomy, post-transplant and severe respiratory failure of multiple causes—cohort review for predictors of elevated plasma-free Hb | ||
| Staudacher 2016 [17] | Germany | 2010–2013 | 90 | 90/0/0 | 2.2 (+/−2.7) | 8 g/dL | 67.8% | 0.79 (+/−1.51) | 24.4% | R. obs | Nonsurgical—cardiogenic shock after arrest or AMI—cohort comparison of outcomes of antiplatelet therapy vs. none |
| Tanaka 2016 [18] | USA | 2010–2014 | 84 | 84/0/0 | 41.7% | R. obs | Mixed—mostly cardiogenic shock, small postcardiotomy group—cohort review of predictors for vascular access complications | ||||
| Tauber 2016 [19] | Austria | 2010–2012 | 38 | 26/12/0 | 8.5 g/dL | 0.0% | 1.65 (+/−1.87) | Prosp. obs | Mixed—cardiogenic shock and severe respiratory failure—cohort review for predictors of higher transfusion requirement | ||
| Trudzinski 2016 [20] | Germany | 2010–2015 | 63 | 0/63/0 | 22.4 (+/−17.4) | 7 g/dL (or ScvO2<65%) | 0.98 (+/−1.17) | 66.7% | R. obs | Nonsurgical—half ARDS, half chronic lung disease awaiting transplant | |
| Agerstrand 2015 [21] | USA | 2010–2012 | 38 | 4/34/0 | 9.2 (+/−3.5) | 7g/dL | 36.8% | 0.15 (+/−0.25) | 73.7% | R. obs | Nonsurgical—respiratory +/− cardiac failure due to ARDS of varying aetiologies—cohort report on restrictive approach to transfusions |
| Esper 2015 [22] | USA | 2007–2013 | 18 | 18/0/0 | 3.3 (+/−2.2) | 5.6% | 3.47 (+/−2.36) | 66.7% | R. obs | Nonsurgical—cardiogenic shock after AMI | |
| Halaweish 2015 [23] | USA | 2002–2013 | 95 | 18/66/11 | 15.5 (+/−13.4) | 0.18 (+/−0.16) | 63.2% | R. obs | Mixed—mainly respiratory failure (75); also cardiogenic shock (14) and eCPR (6)—cohort comparison of roller and centrifugal pumps, only duration >5days | ||
| Ius 2015 [24] | Germany | 2012–2014 | 10 | 10/0/0 | 10.2 (+/−4.2) | 10.0% | 1.75 (+/−1.78) | 50.0% | R. obs | Nonsurgical—acute on chronic respiratory failure—cohort of VV ECMO requiring conversion to VV-A | |
| Lehle 2015 [25] | Germany | 2009–2014 | 318 | 0/318/0 | 8 g/dL | 0.31 (+/−0.36) | R. obs | Nonsurgical—mixed respiratory failure cohort (pneumonia, trauma, acute on chronic lung disease, pulmonary haemorrhage)—cohort report on predictors of ECMO-associated haemolysis | |||
| Li 2015 [26] | China | 2011–2012 | 123 | 123/0/0 | 4.3 (+/−3.7) | 30% | 4.49 (+/−2.88) | 34.1% | R. obs | Surgical—cardiogenic shock post-cardiotomy | |
| Mohite 2015 [27] | UK | 2010–2014 | 59 | 59/0/0 | 8.9 (+/−5.1) | 2.56 (+/−1.81) | R. obs | Mixed—cardiogenic shock (decompensated heart failure, postcardiotomy, post-AMI)—cohort comparison of outcomes between sedated and “awake” ECMO patients | |||
| Omar 2015 [28] | USA | 2007–2013 | 154 | 126/28/0 | 5.6 (+/−6.6) | 5.50 (+/−5.71) | 33.1% | R. obs | Mixed—mainly cardiogenic shock (cardiomyopathy, eCPR, AMI, postcardiotomy, heart transplant, PE) with smaller group respiratory failure and lung transplant—cohort report on predictors of mortality on ECMO, including plasma-free Hb | ||
| Panigada 2015 [29] | Italy | 2011–2013 | 22 | 0/22/0 | 9.0 (+/−5.5) | 0.97 (+/−1.09) | Prosp. obs | Nonsurgical—respiratory failure due to ARDS/COPD or bridge to lung transplant—cohort report comparing clinical, lab and CT findings for oxygenator thrombosis | |||
| Poss 2015 [30] | Germany | 2012–2013 | 15 | 15/0/0 | 26.7% | 66.7% | R. obs 3ctr | Nonsurgical—cardiogenic shock, mostly post-AMI, some myocarditis—cohort comparison of ECMO vs. i-Cor assist device | |||
| San Roman 2015 [31] | Argentina | 2011–2014 | 22 | 9/13/0 | 5.1 (+/−4.3) | 0.0% | 0.89 (+/−1.02) | 68.2% | R. obs | Mixed—cardiorespiratory failure in pre- and postoperative lung transplant plus group of non-transplant respiratory failure | |
| Voelker 2015 [32] | Germany | 2009–2011 | 18 | 0/18/0 | 21.7 (+/−30.0) | 7 g/dL | 1.35 (+/−1.16) | 61.1% | R. obs | Nonsurgical—respiratory failure (pneumonia, trauma, other)—cohort report on restrictive transfusion approach | |
| Wu 2015 [33] | Taiwan | 2008–2014 | 19 | 10/9/0 | 7.0 (+/−4.8) | 3.49 (+/−3.62) | 68.4% | R. obs | Nonsurgical—respiratory failure (trauma-associated ARDS) | ||
| Guirand 2014 [34] | USA | 2001–2009 | 26 | 0/26/0 | 9.3 (+/−9.5) | 0.90 (+/−0.36) | 57.7% | R. obs | Nonsurgical—respiratory failure (trauma-associated ARDS) | ||
| Loforte 2014 [35] | Italy | 2006–2012 | 228 | 228/0/0 | 10.8 (+/−9.2) | 28% | 0.0% | 1.29 (+/−1.03) | 63.2% | R. obs 2 ctr | Mixed—cardiogenic shock, mostly postcardiotomy (118), transplant failure (37), post-AMI (27), decompensated heart failure (40) and myocarditis (6) |
| Roch 2014 [36] | France | 2009–2013 | 85 | 8/77/0 | 9.7 (+/−4.5) | 10 g/dL | 0.90 (+/−0.86) | 43.5% | R. obs | Nonsurgical—respiratory failure (ARDS) | |
| Shum 2014 [37] | Hong Kong | 2009–2013 | 37 | 13/24/0 | 5.5 (+/−2.3) | 0.0% | 0.53 (+/−0.72) | 73.0% | R. obs | Nonsurgical—mostly pneumonia, smaller cohort myocarditis—cohort report on regional citrate anticoagulation for haemodialysis access via ECMO circuit | |
| Fagnoul 2013 [38] | Belgium | 2012–2012 | 24 | 24/0/0 | 1.6 (+/−2.1) | 7 g/dL | 12.5% | 8.90 (+/−11.25) | 25.0% | Prosp. obs | Nonsurgical—eCPR |
| Michaels 2013 [39] | USA | 2009–2010 | 15 | 7/8/0 | 9.8 (+/−1.0) | 3.90 (NR) | 60.0% | R. obs | Nonsurgical—respiratory failure (H1N1 influenza) | ||
| Mikus 2013 [40] | Italy | 2007–2011 | 14 | 14/0/0 | 9.0 (+/−13.8) | 28% | 0.0% | 6.00 (+/−0.84) | 42.9% | R. obs | Surgical—postcardiotomy cardiogenic shock—cohort report on CentriMag pump |
| Pieri 2013 [41] | Italy | 2009–2012 | 16 | 13/3/0 | 6.0 (+/−4.0) | 8 g/dL28% | 1.58 (+/−1.20) | R. obs | Mixed—cardiogenic shock (mixed primary CS or postsurgical) or ARDS—cohort report on use of phosphorylcholine-coated oxygenator | ||
| Repesse 2013 [42] | France | 2006–2011 | 15 | 11/4/0 | 17.3 (+/−8.9) | 24% | 0.96 (+/−0.26) | R. obs | Mixed—cardiogenic shock (mixed primary CS or postsurgical) or ARDS—cohort report of use of recombinant factor VIIa for refractory bleeding on ECMO | ||
| Loforte 2012 [43] | Italy | 2007–2011 | 73 | 73/0/0 | 10.9 (+/−7.6) | 28% | 0.0% | 1.23 (+/−1.04) | 45.2% | R. obs | Mixed—cardiogenic shock, mostly postcardiotomy (50/73), 12/73 post-AMI and 8/73 post-heart transplant |
| Park 2012 [44] | Brazil | Not reported | 10 | 2/8/0 | 9.2 (+/−9.4) | 60.0% | 0.24 (+/−0.39) | 40.0% | R. obs | Nonsurgical—mixed respiratory failure (mostly pneumonia)—cohort of patients from commencement of ECMO service in this hospital | |
| Garcia 2011 [45] | USA | 2009–2009 | 10 | 0/10/0 | 20.0 (+/−15.0) | 35% | 2.44 (+/−1.60) | 60.0% | R. obs | Nonsurgical—mixed respiratory failure (ARDS, advanced chronic respiratory disease pending lung Tx)—cohort report on ambulating VV ECMO patients | |
| Han 2011 [46] | South Korea | 2006–2009 | 68 | 59/9/0 | 5.3 (+/−6.6) | 35% | 6.03 (+/−6.23) | R. obs | Nonsurgical—cardiogenic shock or respiratory failure (ARDS)—comparison of nafamostat vs. heparin for anticoagulation during ECMO; large cohort of eCPR (41/68) | ||
| Lamarche 2011 [47] | Canada | 2000–2009 | 32 | 32/0/0 | 2.2 (+/−2.0) | 9.08 (+/−8.66) | R. obs | Mixed—cardiogenic shock, primary or associated with cardiac surgery, some eCPR-comparison of Impella vs. ECMO | |||
| Formica 2010 [48] | Italy | 2002–2009 | 42 | 42/0/0 | 7.9 (+/−5.3) | 30% | 3.10 (+/−3.90) | 38.1% | R. obs | Mixed—cardiogenic shock, primary or associated with cardiac surgery, 2/42 massive PE | |
| Kanji 2010 [49] | Canada | 2002–2006 | 50 | 50/0/0 | 2.9 (+/−2.6) | 10 g/dL | 12.38 (NR) | R. obs | Mixed—cardiogenic shock, primary or associated with cardiac surgery—comparison of peripheral vs. central cannulation with respect to transfusion and bleeding events | ||
| Marasco 2010 [50] | Australia | 2000–2009 | 39 | 39/0/0 | 6.8 (+/−2.6) | 8 g/dL | 3.15 (+/−1.99) | R. obs | Surgical—post-heart transplant primary graft failure | ||
| Rastan 2010 [51] | Germany | 1996–2008 | 517 | 517/0/0 | 3.3 (+/−2.9) | 4.12 (+/−3.67) | 24.8% | R. obs | Surgical—postcardiotomy cardiogenic shock | ||
| Ang 2009 [52] | Singapore | 2003–2006 | 42 | 37/5/0 | 6.5 (+/−3.2) | 10 g/dL | 2.08 (+/−1.49) | 26.2% | R. obs | Mixed—pre- and post-cardiac surgery, myocarditis, PE, severe respiratory failure | |
| Davies 2009 [53] | Australia | 2009–2009 | 68 | 5/65/0 | 10.7 (+/−6.1) | 0.68 (+/−0.67) | R. obs 15 ctr | Nonsurgical—H1N1 pneumonia and other viral ARDS | |||
| Muller 2009 [54] | Germany | 2006–2008 | 60 | 0/60/0 | 9.0 (+/−6.1) | 8 g/dL | 1.00 (+/−1.06) | 45.0% | R. obs | Nonsurgical—mixed severe respiratory failure (pneumonia/trauma/aspiration/sepsis/other) | |
| Bakhtiary 2008 [55] | Germany | 2003–2006 | 45 | 45/0/0 | 6.4 (+/−4.5) | 2.55 (+/−2.03) | 28.9% | R. obs | Surgical—postcardiotomy cardiogenic shock—mixed indications (CABG/valves/LVAD, 2/45 post heart transplant) | ||
| Dietl 2008 [56] | USA | 1994–2006 | 38 | 38/0/0 | 5.6 (+/−2.6) | 5.05 (+/−2.45) | 60.5% | R. obs | Nonsurgical—Hantavirus cardiopulmonary syndrome | ||
| Frenckner 2002 [57] | Sweden | 1995–2002 | 38 | 0/0/38 | 17.0 (+/−12.9) | 2.53 (+/−1.70) | R. obs | Nonsurgical—mixed severe respiratory failure (pneumonia/trauma/PE/aspiration/other) | |||
| Smith 2001 [58] | Australia | 1995–1998 | 17 | 17/0/0 | 4.1 (+/−2.1) | 10 g/dL | 7.21 (+/−3.13) | 41.2% | R. obs | Surgical—postcardiotomy cardiogenic shock | |
| Lewandowski 1997 [59] | Germany | 1989–1995 | 49 | 0/49/0 | 23.1 (+/−19.7) | 15 g/dL | 2.10 (+/−1.90) | 55.1% | R. obs | Nonsurgical—respiratory failure (ARDS) | |
| Peek 1997 [60] | UK | 1989–1995 | 50 | 2/48/0 | 8.6 (+/−7.4) | 14 g/dL | 4.0% | 2.20 (+/−2.00) | 66.0% | R. obs | Nonsurgical—respiratory failure (ARDS/pneumonia/asthma)—mixed cohort |
| Author/year (reference) | Location | Study period start and end year | N | ECMO type (VA/VV/not spec) |
ECMO days (mean +/−SD) | Transfusion trigger (g/dL or HCt %) | % not transfused PRBC on ECMO | PRBC/day (mean +/−SD) | Survival to discharge (%) | Study type | Brief description |
| Butch 1996 [61] | USA | 1988–1994 | 74 | 0/0/74 | 10.9 (+/−10.9) | 14 g/dL | 1.4% | 4.60 (+/−3.77) | 45.9% | R. obs | Nonsurgical—respiratory failure (ARDS/pneumonia/asthma)—mixed cohort (infection, trauma, post-solid organ transplant) |
| Muehrcke 1996 [62] | USA | 1992–1994 | 23 | 23/0/0 | 2.4 (+/−1.5) | 17.84 (+/−8.88) | 31.8% | R. obs | Surgical—postcardiotomy cardiogenic shock |
Abbreviations: ECMO—extracorporeal membrane oxygenation, VA—venoarterial, VV—venovenous, HCt—hematocrit, PRBC—units of packed red blood cells, AMI—acute myocardial infarction; ARDS—acute respiratory distress syndrome; eCPR—ECMO-facilitated cardiopulmonary resuscitation; LVAD—left ventricular assist device; NR—data not reported; SOFA—Sequential Organ Failure Assessment (score); study types: retrospective (R) or prospective (P) observational.