Meta-analysis of the incidence of extracorporeal membrane oxygenation combined with incident thrombosis

doi:10.3969/j.issn.1004-583X.2024.01.001

Abstract

Abstract:

Objective To systematically evaluate the incidence of thrombotic complications in patients treated with extracorporeal membrane oxygenation technology (ECMO). Methods Articles reporting ECMO and incident thrombosis published before December 2022 were systematically searched in the PubMed, EMBASE, Wanfang and CNKI database using the following keywords: “Extracorporeal Membrane Oxygenation or ECMO”, “thrombus or complication”. Two investigators were responsible for screening eligible articles based on the inclusion and exclusion criteria. Meta-analysis and subgroup analysis were performed using Review Manager 5.4 software. The quality of the included articles was evaluated according to the Newcastle-Ottawa Scale (NOS) scoring system. Results A total of 16 literatures involving 1136 patients were selected. Meta-analysis showed that the incidence of thrombosis in ECMO patients was 52.0%(95% $C I$ : 0.30-0.88) and $I 2$ was 91% ( $P$ <0.01). Subgroup analysis showed that the incidence of ECMO concurrent thrombosis in patients <45 years old and 45-59 years old was 27.0%(95% $C I$ : 0.14-0.50) and 53.0%(95% $C I$ : 0.29-0.97), respectively. The incidence of patients with a mean duration of ECMO ≤10 days and >10 days was 50.0%(95% $C I$ : 0.34-0.74) and 39.0%(95% $C I$ : 0.11-1.38), respectively. The incidence of thrombosis with a body mass index(BMI) of 24-27.9 kg/m² and ≥28 kg/m² was 27.0%(95% $C I$ : 0.07-1.07) and 66.0% (95% $C I$ : 0.36-1.23), respectively. The incidence of thrombosis detected by the anticoagulation monitoring methods of partial thromboplastin time (APTT), activated clotting time (ACT) and anti-factor-Xa (anti-Xa) was 57.0%(95% $C I$ : 0.47-0.69), 13.0%(95% $C I$ : 0.08-0.20) and 45.0% (95% $C I$ : 0.36-0.57), respectively. Conclusion The incidence of thrombotic complications in patients treated with ECMO is 52.0%. Patients with an older age, shorter duration of ECMO, greater BMI and monitored for APTT have a higher incidence of thrombotic complications.

Key words: extracorporeal membrane oxygenation, thrombosis, incidence rate

CLC Number:

R654.1

Peng Yimeng, Yao Yang, Li Siyu, Ding Ge, Sun Yanan, Wang Shengyu. Meta-analysis of the incidence of extracorporeal membrane oxygenation combined with incident thrombosis[J]. Clinical Focus, 2024, 39(1): 5-11.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.01.001

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I1/5

Figures/Tables 7

Fig.1 Screening process for included literature

Tab.1 Basic characteristics of included literature

纳入研究	年份	国家/地区	年龄 (岁)	男性 [例(%)]	病例总数	研究类型	V-V	V-A	VA-V	持续时间 (d)	血栓例数
Parzy^[6]	2020	France	48.0±16.0	71(67.6)	105	回顾性研究	105	0	0	10(6,16)	75
Weber^[7]	2018	Germany	59.1±14.4	216(76.9)	281	回顾性研究	281	0	0	99(28,75)	11
Cartwright^[8]	2021	Australia	46.7(41.1, 63.7)	23(59.0)	39	回顾性研究	17	22	0	VA:3(2,5); VV:10(6,13)	26
Chandel^[9]	2021	USA	46(37, 53)	4(16.7)	24	回顾性研究	24	0	0	13(9, 21)	12
Ripoll^[10]	2022	UK	45(39, 56)	24(80.0)	30	回顾性研究	30	0	0	4(1, 5)	13
Moussa^[11]	2021	France	55±14	183(69.1)	265	回顾性研究	265	0	0	7(3,11)	87
Salas De Armas^[12]	2022	USA	30.6±12.6	14(93.3)	15	回顾性研究	15	0	0	11.0(7.5,20.0)	1
Kohs^[13]	2022	USA	51.1±15.9	44(65.7)	67	回顾性研究	23	44	0	7.0±5.0	16
Zhang^[14]	2021	China	47(25,73)	11(73.3)	15	回顾性研究	5	10	0	15.0±18.0	4
Beyls^[15]	2020	France	62(56,66)	10(83.3)	12	回顾性研究	12	0	0	4.0(1.5,7.5)	11
Riera^[16]	2020	Spain	50.5(31.0,64.0)	16(84.2)	19	回顾性研究	19	0	0	8.6(0,17.0)	9
Fong^[17]	2021	Hong Kong	55.0(41.3,62.0)	85(65.4)	130	回顾性研究	79	51	0	5.9(3.6,7.9)	37
Agerstrand^[18]	2016	New York	32.6(26.0,39.0)	0	18	回顾性研究	14	1	3	6.6(6.0,17.8)	5
Trudzinski^[19]	2016	Germany	46.0±14.4	37(58.7)	63	回顾性研究	63	0	0	22.4±17.0	29
Agerstrand^[20]	2015	New York	33(24,53)	24(63.2)	38	回顾性研究	34	2	1	9.0(7.0,11.5)	8
Roussel^[21]	2012	France	52(22, 86)	7(46.7)	15	回顾性研究	0	15	0	4.9(1.0,12.0)	1

Tab.2 Quality evaluation of included literature

纳入研究	①	②	③	④	⑤	⑥	⑦	⑧	⑨	⑩	总分
Parzy^[6]	1	1	1	1	1	0	1	0	1	0	7
Weber^[7]	1	1	1	1	1	0	1	1	0	0	7
Cartwright^[8]	1	1	1	1	1	1	1	1	0	0	8
Chandel^[9]	1	1	1	1	1	1	1	1	0	1	9
Ripoll^[10]	1	1	1	1	1	0	1	1	0	1	8
Moussa^[11]	1	1	1	1	1	1	1	1	0	1	9
Salas De Armas^[12]	1	1	1	1	1	0	1	1	1	1	9
Kohs^[13]	1	1	1	1	1	1	1	1	0	0	8
Zhang^[14]	1	1	1	1	1	0	1	1	0	1	8
Beyls^[15]	1	1	1	1	1	0	1	1	1	0	8
Riera^[16]	1	1	1	1	1	0	1	1	1	0	8
Fong^[17]	1	1	1	1	1	0	1	1	0	1	9
Agerstrand^[18]	1	1	1	1	0	1	0	0	0	1	6
Trudzinski^[19]	1	1	1	1	1	1	1	1	0	1	9
Agerstrand^[20]	1	1	1	1	1	1	1	1	0	1	9
Roussel^[21]	1	1	1	1	0	1	0	0	0	1	6

Fig. 2 Forest plot of thrombosis incidence in ECMO patients

Fig. 3 Funnel plot of thrombosis incidence in ECMO patients

Tab.3 Summary table of Meta-analysis results

亚组	纳入研究数	异质性检验结果		效应模型	患病率(95% $C I$ )
亚组	纳入研究数	$P$ 值	$I 2$ 值	效应模型	患病率(95% $C I$ )
总发生率	16^{[6⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓-21]}	<0.01	91%	随机	52.0%(95% $C I$ :0.30~0.88)
年龄(岁)
<45岁	3^[12,18,20]	0.35	5%	随机	27.0%(95% $C I$ :0.14~0.50)
45~59岁	12^{[6⇓⇓⇓⇓-11,13 -14,16 -17,19,21]}	<0.01	93%	随机	53.0%(95% $C I$ :0.29~0.97)
ECMO时间(d)
≤10	8^{[10,11,13,15⇓⇓ -18,21]}	0.008	63%	随机	50.0%(95% $C I$ :0.34~0.74)
>10	7^{[6-7,9,12,14,18 -19]}	<0.01	95%	随机	39.0%(95% $C I$ :0.11~1.38)
BMI( kg/m²)
24~27.9	5^{[6-7,11 -12,20]}	<0.01	97%	随机	27.0%(95% $C I$ :0.07~1.07)
≥28	6^{[8,13 -14,16,18 -19]}	0.0009	76%	随机	66.0%(95% $C I$ :0.36~1.23)
抗凝监测方式
APTT	8^{[6⇓-8,11 -12,15,18,20]}	<0.01	95%	随机	57.0%(95% $C I$ :0.47~0.69)
ACT	3^[7,14,16]	<0.01	94%	随机	13.0%(95% $C I$ :0.08~0.20)
抗fxa	2^[11,13]	0.16	50%	随机	46.0%(95% $C I$ :0.36~0.57)

Tab.3 Summary table of Meta-analysis results

亚组	纳入研究数	异质性检验结果		效应模型	患病率(95% $C I$ )
亚组	纳入研究数	$P$ 值	$I 2$ 值	效应模型	患病率(95% $C I$ )
总发生率	16^{[6⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓-21]}	<0.01	91%	随机	52.0%(95% $C I$ :0.30~0.88)
年龄(岁)
<45岁	3^[12,18,20]	0.35	5%	随机	27.0%(95% $C I$ :0.14~0.50)
45~59岁	12^{[6⇓⇓⇓⇓-11,13 -14,16 -17,19,21]}	<0.01	93%	随机	53.0%(95% $C I$ :0.29~0.97)
ECMO时间(d)
≤10	8^{[10,11,13,15⇓⇓ -18,21]}	0.008	63%	随机	50.0%(95% $C I$ :0.34~0.74)
>10	7^{[6-7,9,12,14,18 -19]}	<0.01	95%	随机	39.0%(95% $C I$ :0.11~1.38)
BMI( kg/m²)
24~27.9	5^{[6-7,11 -12,20]}	<0.01	97%	随机	27.0%(95% $C I$ :0.07~1.07)
≥28	6^{[8,13 -14,16,18 -19]}	0.0009	76%	随机	66.0%(95% $C I$ :0.36~1.23)
抗凝监测方式
APTT	8^{[6⇓-8,11 -12,15,18,20]}	<0.01	95%	随机	57.0%(95% $C I$ :0.47~0.69)
ACT	3^[7,14,16]	<0.01	94%	随机	13.0%(95% $C I$ :0.08~0.20)
抗fxa	2^[11,13]	0.16	50%	随机	46.0%(95% $C I$ :0.36~0.57)

Tab.4 Sensitivity analysis of thrombosis incidence in ECMO patients

剔除研究	$O R$	$P$ 值	$I 2$ 值	95% $C I$	Tau²
Parzy^[6] 2020	0.45	<0.01	88%	0.28~0.75	0.74
Weber^[7] 2018	0.64	<0.01	85%	0.41~0.99	0.54
Cartwright^[8] 2021	0.47	<0.01	91%	0.27~0.81	0.95
Chandel^[9] 2021	0.49	<0.01	92%	0.28~0.87	1.01
Ripoll^[10] 2022	0.50	<0.01	92%	0.28~0.89	1.03
Moussa^[11] 2021	0.51	<0.01	92%	0.27~0.98	1.36
Salas De Armas^[12] 2022	0.56	<0.01	92%	0.32~0.96	0.96
Kohs^[13] 2021	0.53	<0.01	92%	0.30~0.95	1.04
Zhang^[14] 2021	0.53	<0.01	92%	0.30~0.92	1.00
Beyls^[15] 2020	0.46	<0.01	91%	0.27~0.79	0.94
Riera^[16] 2020	0.50	<0.01	92%	0.28~0.87	1.01
Fong^[17] 2021	0.52	<0.01	92%	0.29~0.96	1.16
Agerstrand^[18] 2016	0.52	<0.01	92%	0.32~0.92	1.01
Trudzinski ^[19]2016	0.49	<0.01	92%	0.28~0.89	1.08
Agerstrand^[20] 2015	0.54	<0.01	92%	0.31~0.95	1.01
Roussel^[21] 2012	0.56	<0.01	92%	0.32~0.96	0.96

Tab.4 Sensitivity analysis of thrombosis incidence in ECMO patients

剔除研究	$O R$	$P$ 值	$I 2$ 值	95% $C I$	Tau²
Parzy^[6] 2020	0.45	<0.01	88%	0.28~0.75	0.74
Weber^[7] 2018	0.64	<0.01	85%	0.41~0.99	0.54
Cartwright^[8] 2021	0.47	<0.01	91%	0.27~0.81	0.95
Chandel^[9] 2021	0.49	<0.01	92%	0.28~0.87	1.01
Ripoll^[10] 2022	0.50	<0.01	92%	0.28~0.89	1.03
Moussa^[11] 2021	0.51	<0.01	92%	0.27~0.98	1.36
Salas De Armas^[12] 2022	0.56	<0.01	92%	0.32~0.96	0.96
Kohs^[13] 2021	0.53	<0.01	92%	0.30~0.95	1.04
Zhang^[14] 2021	0.53	<0.01	92%	0.30~0.92	1.00
Beyls^[15] 2020	0.46	<0.01	91%	0.27~0.79	0.94
Riera^[16] 2020	0.50	<0.01	92%	0.28~0.87	1.01
Fong^[17] 2021	0.52	<0.01	92%	0.29~0.96	1.16
Agerstrand^[18] 2016	0.52	<0.01	92%	0.32~0.92	1.01
Trudzinski ^[19]2016	0.49	<0.01	92%	0.28~0.89	1.08
Agerstrand^[20] 2015	0.54	<0.01	92%	0.31~0.95	1.01
Roussel^[21] 2012	0.56	<0.01	92%	0.32~0.96	0.96

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