BACKGROUND Postcardiotomy cardiogenic shock (PCS) that is refractory to inotropic support remains a major concern in cardiac surgery and is almost universally fatal unless treated with mechanical support. While reported mortality rates on ECMO vary from center to center, aim of the current report is assess if the outcomes differ between centres according to volume and heart transplantation status. METHODS A systematic search was performed according to PRISMA statement using PubMed/Medline databases between 2010 and 2018. Relevant articles were scrutinized and included in the meta-analysis only if reporting in-hospital/30-day mortality and heart transplantation status of the centre. Paediatric and congenital heart surgery-related studies along with those conducted in the setting of veno-venous ECMO for respiratory distress syndrome were excluded. Differences were assessed by means of subgroup meta-analysis and meta-regression. RESULTS Fifty-four studies enrolling N = 4421 ECMO patients were included. Of those, 6 series were performed in non-HTx centres (204 pts.;4.6%). Overall 30-day survival (95% Confidence Intervals) was 35.3% (32.5-38.2%) and did not statistically differ between non-HTx: 33.3% (26.8-40.4%) and HTx centres: 35.7% (32.7-38.8%); Pinteraction = 0.531. There was no impact of centre volume on survival as well: ßcoef = 0.0006; P = 0.833. No statistical differences were seen between HTx and non-HTx with respect to ECMO duration, limb complications, reoperations for bleeding, kidney injury and sepsis. There were however significantly less neurological complications in the HTx as compared to non-HTx centres: 11.9% vs 19.5% respectively; P = 0.009; an inverse relationship was seen for neurologic complications in centres performing more ECMOs annually ßcoef = - 0.0066; P = 0.031. Weaning rates and bridging to HTx and/or VADs were higher in HTx facilities. CONCLUSIONS There was no apparent difference in survival after ECMO implantation for refractory PCS according to centre's ECMO volume and transplantation status. Potentially different risk profiles of patients in these centres must be taken account for before definite conclusions are drawn.

中文翻译：

---

对于难治性心脏切开术后心源性休克，体外膜氧合后，中心的心脏移植状态和体积对院内结局的影响：一项荟萃分析。

背景技术在心脏手术中，对于正性肌力支持难治的心脏切开术后的心源性休克（PCS）仍然是主要的问题，除非使用机械支持治疗，否则几乎是致命的。尽管报告的ECMO死亡率因中心而异，但本报告的目的是评估中心之间的结局是否根据容量和心脏移植状况而有所不同。方法在2010年至2018年之间，根据PRISMA声明，使用PubMed / Medline数据库进行了系统搜索。只有在报告中心的院内/ 30天死亡率和心脏移植状况时，才对相关文章进行审查并纳入荟萃分析。与儿科和先天性心脏手术相关的研究，以及在进行呼吸窘迫综合征的静脉-静脉ECMO设置中进行的研究均被排除在外。通过亚组荟萃分析和荟萃回归评估差异。结果纳入了54项研究，共纳入N = 4421名ECMO患者。其中，有6个系列在非HTx中心进行（204分； 4.6％）。30天总生存期（95％置信区间）为35.3％（32.5-38.2％），非HTx中心：33.3％（26.8-40.4％）和HTx中心之间的统计差异无统计学意义：35.7％（32.7-38.8％） ; 交互作用= 0.531。中心容积对生存也没有影响：ßcoef= 0.0006；P ＝ 0.833。HTx和非HTx在ECMO时间，肢体并发症，再次手术出血，肾损伤和败血症方面无统计学差异。然而，与非HTx中心相比，HTx的神经系统并发症明显更少：分别为11.9％和19.5％；P = 0.009；在每年执行更多ECMO的中心，神经系统并发症呈反比关系ßcoef=-0.0066；P ＝ 0.031。HTx设施的断奶率和与HTx和/或VAD的桥接更高。结论根据中心的ECMO量和移植状态，难治性PCS的ECMO植入后生存期无明显差异。在得出明确结论之前，必须考虑这些中心患者的潜在风险状况。