A systematic review and meta-analysis of the timing of rehabilitation training intervention for recipients of extracorporeal membrane oxygenators
Description
Introduction: The use of mechanical ventilation and sedatives in patients who undergo extracorporeal membrane oxygenation (ECMO) significantly increase the risk of disability. Rehabilitation training intervention (RTI) has the potential to enhance their cardiac function, exercise endurance, as well as overall hospitalization time and survival rate. However, the optimal timing of its initiation remains underexplored and lacks systematic evaluation. Methods: A systematic review and meta-analysis were conducted to compare the effects of early and delayed RTI on recovery outcomes in patients undergo ECMO. Literature related to the timing of RTI during ECMO was retrieved from online databases including Embase, Pubmed, WOS, Science Direct, CNKI, VIP, and CBM. After screening and quality assessment, the effect sizes of rehabilitation outcomes were synthesized and evaluated. Results: This study includes 5 randomized controlled trials, 4 non-randomized controlled trials, and 3 observational cohort studies. The meta-analysis results showed that the application of early RTI significantly reduced the risk of complications in ECMO patients compared to delayed RTI (Risk Ratio (RR)=0.43, 95% Confidence Interval (CI) [0.26; 0.69], Z=-3.48, P<0.001). Early RTI also shortened the stay time in ICU (Mean difference (MD)=-1.12, 95% CI [-1.30; -0.94], Z=-12.41, P<0.001), reduced hospitalization time (MD=-4.69, 95% CI [-8.11; -1.27], Z=-2.69, P=0.007), but did not significantly impact the mechanical ventilation time (MD=0.14, 95% CI [-2.48; 2.77], Z=0.11). P=0.914), ECMO duration (MD=-1.77, 95% CI [-4.10; 0.56], Z=-1.49, P=0.136), and in-hospital mortality (RR=0.72, 95% CI [0.49; 1.06], Z=-1.66, P=0.097). Conclusion: Compared to delayed RTI, early RTI is associated with a reduced risk of complications and improved rehabilitation outcomes in ECMO patients. However, due to the relatively low level of evidence in this meta-analysis, further exploration is still needed on this topic.
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Quality assessment The Cochrane Risk of Bias V2.0 (12) provided by the Cochrane Collaboration was used to assess the risk of bias in the included studies, which included five levels, each of which was evaluated as "low", "some concern of risk", and "high". Data extraction Two researchers conducted a detailed data extraction of existing literature using a structured approach, covering basic details such as author, publication year, country, trial duration, identifier, sample size, gender, age, follow-up time, and outcome measures. Outcomes and effect size The main outcome measures were ultimately determined as the hospital length of stay (LOS), the ICU LOS, duration of ECMO, mechanical ventilation time, incidence of complications, and in-hospital mortality. For hospital LOS, ICU LOS, ECMO duration, and mechanical ventilation time, the mean difference (MD) was adopted as the effect size to measure between early RTI and delayed RTI, while for complication incidence and in-hospital mortality, a risk ratio (RR) was adopted as the effect size. Statistical analysis The Cochrane Q test and I2 statistics were used to evaluate heterogeneity across the studies. If significant heterogeneity was detected (I2>50% or Cochrane P <0.05), a random effects model was adopted; otherwise, a fixed effects model was used. Sensitivity analysis was conducted using the leave-one-out strategy. Egger’ test was used to assess the publication bias and presented it in a funnel plot. A P-value less than 0.05 is considered statistically significant.
Institutions
- Tongde Hospital of Zhejiang Province
- Zhejiang Provincial People's Hospital