Impact of awake extracorporeal membrane oxygenation on patients mortality with cardiogenic shock: a systematic review and trial sequential meta-analysis based on observational studies

Objectives The use of awake extracorporeal membrane oxygenation (ECMO, without intubation or sedation under ECMO support in patients with cardiogenic shock is growing rapidly because emerging clinical investigations indicates it may reduce morbidity associated with sedation and intubation. We systematically reviewed the efficacy of awake ECMO and provided evidence for clinical practitioners and researchers.Design Systematic review and trial sequential meta-analysis based on observational studies.Data sources Data was retrieved from seven databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database and Cochrane Library) up to 1 March 2024.Eligibility criteria We included observational studies that compared the differences in clinical outcomes between awake ECMO and non-awake ECMO in patients with cardiogenic shock.Data extraction and synthesis Two reviewers rigorously conducted literature retrieval, screening and data extraction. The RevMan software was used for data synthesis.Results Five retrospective observational studies involving 1044 patients with cardiogenic shock were included. Compared with non-awake ECMO, awake ECMO was associated with a lower mortality rate of patients with cardiogenic shock (OR=0.28; 95% CI, (0.15, 0.49); p