Utilization and Outcomes of Extracorporeal Membrane Oxygenation in China and Scandinavia: A Systemic Literature Review

OBJECTIVES: To demonstrate the differences in utilization and outcomes of Extracorporeal Membrane Oxygenation (ECMO) between China and Scandinavia.

METHODS: English bibliographic databases were searched from 2013 to 2023 to identify observational studies assessing ECMO in China and Scandinavian countries (Denmark, Norway, Sweden, and Finland). Data on patient characteristics, ECMO utilization, clinical outcomes, and health resource utilization were extracted and synthesized using single-arm meta-analysis with a random effects model. The pooled outcomes for China and Scandinavia were compared using the Z-test.

RESULTS: Twenty-five studies from China and sixteen from Scandinavia were included. Patients undergoing ECMO for respiratory failure in the two regions showed significant differences in age (54.7 vs. 45.5 years, P=0.019), admission diagnoses of viral pneumonia (78.5% vs. 25.9%, p<0.001) and bacterial pneumonia (10.3% vs. 44.4%, p<0.001), ECMO weaning rate (46.0% vs. 78.2%, p<0.001), mechanical ventilation duration (14.0 vs. 31.0 days, p=0.001), and hospital stay length (25.5 vs. 54.0 days, p=0.006). For cardiogenic shock, the identified differences included arrhythmia comorbidity (16.9% vs. 44.0%, p<0.001), admission diagnoses (acute fulminant myocarditis: 47.6% vs. 10.0%, p<0.001; cardiomyopathy: 12.8% vs. 32.0%, p<0.001; ischemic heart disease: 12.4% vs. 27.0%, p=0.002), and ECMO duration (5.6 vs. 8.0 days, p=0.008). For cardiac arrest, the distributions of comorbidity for heart failure (13.4% vs. 7.6%, p=0.009) and diabetes (19.4% vs. 9.7%, p<0.001), and in-hospital mortality (66.3% vs. 75.3%, p<0.001) were found significantly different. In addition, the pooled complication rates irrespective of clinical conditions varied significantly in infection (40.6% vs. 14.9%, p=0.006), mechanical injury (16.0% vs. 1.5%, p=0.013), abnormal liver function (29.9% vs. 3.2%, p=0.005), pneumothorax (5.2% vs. 23.5%, p=0.002), and pulmonary embolism (7.9% vs. 23.5%, p=0.027).

CONCLUSIONS: ECMO utilization for respiratory failure, cardiac arrest, and cardiogenic shock had significant differences in clinical outcomes and health resource utilization between China and Scandinavia, likely influenced by patient characteristics, admission diagnoses, operational experience, and healthcare system.