Abstract 4336054: Extracorporeal membrane oxygenation and the Gender Divide: A Systematic Review and Meta-Analysis of Sex-Based Differences in Outcomes

Abstract

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly utilized method for circulatory support. However, despite continued research, survival rates following VA-ECMO therapy remain low. Sex-related differences may influence treatment outcomes. We aimed to evaluate the effects of gender on clinical outcomes in patients who underwent VA-ECMO as a bridge to recovery. Methods: PubMed, Scopus and Cochrane databases were systematically searched for observational studies comparing the impact of male versus female genders on clinical outcomes in patients who underwent ECMO therapy. The primary outcome of interest is all-cause mortality. The secondary outcomes evaluated were stroke, renal failure requiring dialysis, heart transplant, pneumonia, cardiovascular death, admission for heart failure, respiratory failure, limb ischemia and bleeding. We pooled odds ratio (OR) along with its 95% confidence interval (CIs) with random-effect model. Results: We included 8 observational studies consisting of 17,471 patients of which 11,053 (63.3 %) are male and 6,418 (36.7 %) are female patients. The mean age of these patients ranged from 54.6 ± 9.3 years and 63.3 % were male. The pooled odds ratio analysis showed that there were no significant differences between groups for in-hospital mortality (OR = 0.97; 95% CI [0.79; 1.20]; I 2 = 74%; p = 0.78), renal failure requiring dialysis (OR = 1.25; 95% CI [0.92; 1.69]; I 2 = 81%; p = 0.15), heart transplant (OR = 1.65; 95% CI [0.12; 23.07]; I 2 = 43%; p = 0.711), stroke (OR = 1.23; 95% CI [0.92; 1.64]; I 2 = 0%; p = 0.162), pneumonia (OR = 0.42; 95% CI [0.05; 3.69]; I 2 = 90%; p = 0.433), admission for heart failure (OR = 1.24; 95% CI [0.94; 1.64]; I 2 = 0%; p = 0.119), respiratory failure (OR = 1.18; 95% CI [0.50; 2.81]; I 2 = 69%; p = 0.707), limb ischemia (OR = 0.90; 95% CI [0.41; 1.97]; I 2 = 53%; p = 0.790) and bleeding (OR = 0.84; 95% CI [0.60; 1.16]; I 2 = 0%; p = 0.286). However, the incidence of cardiovascular death (OR = 1.52; 95% CI [1.19; 1.94]; I 2 = 0%; p < 0.001) is higher in female patients compared to male patients. Conclusions: Our meta-analysis showed that the rate of cardiovascular death is higher in female compared to male. However, there were no sex-specific discrepancies in patients treated with ECMO for in-hospital mortality, renal failure requiring dialysis, heart transplantation, stroke, pneumonia, admission for heart failure, respiratory failure, limb ischemia and bleeding.