Evidence map›Paper›PMID 39695889›Full record

ReviewJournal of anesthesia, analgesia and critical care2024

Intraoperative extracorporeal support for lung transplant: a systematic review and network meta-analysis.

Tommaso Pettenuzzo, Honoria Ocagli, Nicolò Sella, Alessandro De Cassai, Francesco Zarantonello, Sabrina Congedi, Maria Vittoria Chiaruttini, Elisa Pistollato, Marco Nardelli, Martina Biscaro and 8 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of anesthesia, analgesia and critical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Tommaso Pettenuzzo *Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
Honoria Ocagli *Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Nicolò SellaInstitute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
Alessandro De CassaiInstitute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
Francesco ZarantonelloInstitute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
Sabrina CongediDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Maria Vittoria ChiaruttiniUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Elisa PistollatoDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Marco NardelliDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Martina BiscaroDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Mara BassiDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Giordana ConiglioDepartment of Medicine (DIMED), Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Eleonora FaccioliDepartment of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy.
Federico ReaDepartment of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy.
Dario GregoriUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Paolo Navalesi *Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy. paolo.navalesi@unipd.it.
Annalisa Boscolo *Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
PADOVA ICU Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn 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.

methodsA 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).

findingsTwenty-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/m

interpretationThis 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.

Indexed as

Cardiopulmonary bypassCPBECMOExtracorporeal membrane oxygenationLung transplantTransplantation

Identifiers

PMID39695889
PMCPMC11658095

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.