[Distal perfusion cannulae in preventing limb ischemia in venous-arterial extracorporeal membrane oxygenation: a Meta-analysis].

OBJECTIVE To evaluate the effect of distal perfusion catheter (DPC) on the incidence and prognosis of venous-arterial extracorporeal membrane pulmonary oxygenation (VA-ECMO) arterial catheter-related limb ischemia. METHODS Literatures on the effect of DPC on catheter-related limb ischemia in VA-ECMO patients in Chinese and English databases such as CNKI, Wanfang Medical Database, PubMed, Embase, Scopus, Cochrane Library and Google Scholar were searched from building the database to February 2019. Keywords were extracorporeal membrane oxygenation, limb ischemia, extracorporeal membrane oxygenation, distal perfusion cannula. Outcome indicators included the incidence of limb ischemia and mortality. Two reviewers selected documents according to the inclusion and exclusion criteria, extracted data, and applied RevMan 5.3 software for Meta-analysis. Sensitivity analysis was used to test the stability of the Meta-analysis results, and funnel chart analysis was used to analyze publication bias. RESULTS There were totally 17 articles selected for review, including 11 series studies, 2 technical description studies and 4 retrospective cohort studies. Totally 1 850 patients, including 1 180 patients who had already received DPC in preventing limb ischemia, 670 patients who had not received DPC. Meta-analysis showed that compared to no DPC, the presence of DPC could reduce the incidence of limb ischemia [relative risk (RR) = 0.48, 95% confidence interval (95%CI) was 0.37-0.62, P < 0.000 1]. However, there was no significant difference in mortality between the two groups [odds ratio (OR) was 1.41, 95%CI was 0.70-2.87, P < 0.000 5]. Sensitivity analysis excluded the effect of heterogeneity on statistical results. Funnel plot showed that the distribution of the included literatures was basically symmetrical, indicating a small publication bias. CONCLUSIONS DPC can reduce the incidence of catheter-related limb ischemia in patients with VA-ECMO. Due to the small amount of studies and the influence of population heterogeneity and other factors, more large-sample and high-quality randomized controlled trial (RCT) studies are still needed.