Prognosis of Immunocompromised Patients With Respiratory Failure Managed With Venovenous Extracorporeal Membrane Oxygenation.
Natsumi T Hamahata, Jonathan D Paladino, Makoto Uchiyama et al.
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In 30 seconds
This systematic review and meta-analysis examined mortality among immunocompromised adults with respiratory failure managed with venovenous extracorporeal membrane oxygenation (VV ECMO), compared with immunocompetent patients, and assessed differences by immunocompromising condition. Across 13 studies, pooled mortality in immunocompromised patients was 63% (95% confidence interval [CI]: 49-76%). Their mortality was higher than that of immunocompetent patients (odds ratio [OR]: 2.57, 95% CI: 1.22-5.41, p = 0.03). Among immunocompromised subgroups, significantly higher mortality was observed only in patients with hematologic malignancy.
Key findings
- Pooled mortality among immunocompromised patients receiving VV ECMO was 63% (95% confidence interval [CI]: 49-76%).
- Mortality was higher in immunocompromised than immunocompetent patients (odds ratio [OR]: 2.57, 95% CI: 1.22-5.41, p = 0.03).
- Among immunocompromised subgroups, only patients with hematologic malignancy had significantly higher mortality (OR: 5.78, 95% CI: 1.07-31.29, p = 0.05).
Why it matters
The findings indicate that prognosis during VV ECMO for respiratory failure differs with immune status and may vary by the underlying cause of immunosuppression. This context can inform discussions of expected outcomes and underscores that a broad immunocompromised label may not capture clinically relevant differences. The pooled estimates also show substantial uncertainty and heterogeneity in the overall immunocompromised group.
What to keep in mind
The review included only 13 studies of any design, and pooled mortality among immunocompromised patients had substantial heterogeneity (I2 : 94.23%).