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Burrell A, Kim J, Alliegro P, Romero L, Serpa Neto A, Mariajoseph F, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev 2023; 9:CD010381. [PMID: 37750499 PMCID: PMC10521169 DOI: 10.1002/14651858.cd010381.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) may provide benefit in certain populations of adults, including those with severe cardiac failure, severe respiratory failure, and cardiac arrest. However, it is also associated with serious short- and long-term complications, and there remains a lack of high-quality evidence to guide practice. Recently several large randomized controlled trials (RCTs) have been published, therefore, we undertook an update of our previous systematic review published in 2014. OBJECTIVES To evaluate whether venovenous (VV), venoarterial (VA), or ECMO cardiopulmonary resuscitation (ECPR) improve mortality compared to conventional cardiopulmonary support in critically ill adults. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was March 2022. The search was limited to English language only. SELECTION CRITERIA We included RCTs, quasi-RCTs, and cluster-RCTs that compared VV ECMO, VA ECMO or ECPR to conventional support in critically ill adults. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was 1. all-cause mortality at day 90 to one year. Our secondary outcomes were 2. length of hospital stay, 3. survival to discharge, 4. disability, 5. adverse outcomes/safety events, 6. health-related quality of life, 7. longer-term health status, and 8. cost-effectiveness. We used GRADE to assess certainty of evidence. MAIN RESULTS Five RCTs met our inclusion criteria, with four new studies being added to the original review (total 757 participants). Two studies were of VV ECMO (429 participants), one VA ECMO (41 participants), and two ECPR (285 participants). Four RCTs had a low risk of bias and one was unclear, and the overall certainty of the results (GRADE score) was moderate, reduced primarily due to indirectness of the study populations and interventions. ECMO was associated with a reduction in 90-day to one-year mortality compared to conventional treatment (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.70 to 0.92; P = 0.002, I2 = 11%). This finding remained stable after performing a sensitivity analysis by removing the single trial with an uncertain risk of bias. Subgroup analyses did not reveal a significant subgroup effect across VV, VA, or ECPR modes (P = 0.73). Four studies reported an increased risk of major hemorrhage with ECMO (RR 3.32, 95% CI 1.90 to 5.82; P < 0.001), while two studies reported no difference in favorable neurologic outcome (RR 2.83, 95% CI 0.36 to 22.42; P = 0.32). Other secondary outcomes were not consistently reported across the studies. AUTHORS' CONCLUSIONS In this updated systematic review, which included four additional RCTs, we found that ECMO was associated with a reduction in day-90 to one-year all-cause mortality, as well as three times increased risk of bleeding. However, the certainty of this result was only low to moderate, limited by a low number of small trials, clinical heterogeneity, and indirectness across studies.
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Affiliation(s)
- Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| | - Jiwon Kim
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Patricia Alliegro
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Hospital, Melbourne, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Intensive Care, Austin Hospital, Melbourne, Australia
| | - Frederick Mariajoseph
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia
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Extracorporeal Membrane Oxygenation Support for Influenza A: Retrospective Review of the Extracorporeal Life Support Organization Registry Comparing H1N1 With Other Subtypes. Crit Care Explor 2021; 3:e0598. [PMID: 34909701 PMCID: PMC8663836 DOI: 10.1097/cce.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Although there is a substantial published experience of extracorporeal membrane oxygenation during the H1N1 pandemic, less is known about the use of extracorporeal membrane oxygenation in patients with other subtypes of the influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation would differ for those with H1N1 influenza A compared with other subtypes of influenza A. DESIGN, SETTING, PATIENTS: Retrospective study of extracorporeal membrane oxygenation–supported adults (> 18 yr) with influenza A viral infection reported to the Extracorporeal Life Support Organization Registry between 2009 and 2019. We describe the frequency and compare characteristics and factors associated with in-hospital survival using a least absolute shrinkage and selection operator regression analysis. MAIN OUTCOMES AND MEASURES: Of 2,461 patients supported with extracorporeal membrane oxygenation for influenza A, 445 had H1N1, and 2,004 had other subtypes of influenza A. H1N1 was the predominant subtype between 2009 and 2011. H1N1 patients were younger, with more severe illness at extracorporeal membrane oxygenation cannulation and higher reported extracorporeal membrane oxygenation complications than those with other influenza A subtypes. Patient characteristics including younger age and higher weight and patient management characteristics including longer ventilation duration before extracorporeal membrane oxygenation were associated with worse survival. Extracorporeal membrane oxygenation complications were associated with reduced survival. There was no difference in survival to hospital discharge according to influenza subtype after adjusting for other characteristics. CONCLUSIONS: Patients supported with extracorporeal membrane oxygenation for H1N1 were younger, with more severe illness than those supported for other influenza A subtypes. Survival to hospital discharge was associated with patient characteristics, management characteristics, and extracorporeal membrane oxygenation complications but was not impacted by the specific influenza A subtype.
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Periche Pedra E, Koborzan MR, Sbraga F, Blasco Lucas A, Toral Sepúlveda D. Outcomes of extracorporeal membrane oxygenation in adult patients with hypoxemic respiratory failure refractory to mechanical ventilation. Respir Med Case Rep 2018; 25:220-224. [PMID: 30237974 PMCID: PMC6143695 DOI: 10.1016/j.rmcr.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that has been used to support cardiopulmonary disease refractory to conventional therapy. The experience with the use of ECMO in acute hypoxemic respiratory failure is still limited. The aim of this study was to report clinical outcomes in adult patients with acute hypoxemic respiratory failure refractory to mechanical ventilation treated with ECMO. Methods Between July 2011 and October 2017, 18 adult patients with hypoxemic respiratory failure refractory to mechanical ventilation were admitted to the Intensive Care Unit of an acute care tertiary hospital in Barcelona, Spain. These patients were treated with ECMO as salvage respiratory therapy. Outcomes included clinical data, ventilatory and blood gas characteristics, survival, and complications. Results Fifteen patients (83.3%) were previously treated in prone position. The indication of VV-ECMO was established at an early stage after a mean (SD) of 3.8 (2.5) days on mechanical ventilation. The mean duration of ECMO was 10.4 days, and 16 patients (88.9%) required venous cannulation, mostly femoral-internal jugular. The mean length of ICU stay was 27 days and the mean hospital stay was 42.1 days. The ICU survival rate was 55.5% (n = 10) and the hospital survival rate was 50% (n = 9). Conclusions This clinical study in a small series of ICU patients treated with ECMO confirms the usefulness of this technique as a ventilatory support in patients with refractory hypoxemic respiratory failure. However, the indication of this procedure is also committed to an ethical reflection considering the possible futility of the measure on a case-by-case basis and associated complications.
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Affiliation(s)
- Elisabet Periche Pedra
- Intensive Care Unit, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Corresponding author. Intensive Care Unit, Hospital Universitario de Bellvitge, C/ Feixa Llarga s/n, E-08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Melinda Rita Koborzan
- Intensive Care Unit, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fabrizio Sbraga
- Service of Cardiac Surgery, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arnau Blasco Lucas
- Service of Cardiac Surgery, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Toral Sepúlveda
- Service of Cardiac Surgery, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, Zein A, Khatani N, Al-Hameed F, Alamri S, Abdelzaher M, Alghamdi A, Alfousan F, Tash A, Tashkandi W, Alraddadi R, Lewis K, Badawee M, Arabi YM, Fan E, Alhazzani W. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care 2018; 8:3. [PMID: 29330690 PMCID: PMC5768582 DOI: 10.1186/s13613-017-0350-x] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 12/29/2017] [Indexed: 12/15/2022] Open
Abstract
Background Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. Methods We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. Results Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). Conclusions ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.
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Affiliation(s)
- Mohammed S Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, PO Box 40236, Al Khobar, 31952, Saudi Arabia.
| | - Anees Sindi
- Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Awad Al-Omari
- Medical Director of Critical Care, Dr. Suliman Al-Habib Group, AlFaisal University, Riyadh, Saudi Arabia
| | - Mohamed El Tahan
- Department of Anesthesiology, Dammam University, Dammam, Saudi Arabia
| | | | - Ahmed Zein
- Department of ICU, King Fahad Hospital, Jeddah, Saudi Arabia
| | | | - Fahad Al-Hameed
- King Abdulaziz Medical City, NGHA, Jeddah, Saudi Arabia.,Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sultan Alamri
- Department of ICU National Hospital, Internal Medicine and Critical Care, Riyadh, Saudi Arabia
| | | | - Amenah Alghamdi
- Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal Alfousan
- Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Tash
- Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Wail Tashkandi
- Department of Surgery/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rajaa Alraddadi
- Community Medicine Department, Ministry of Health, Jeddah, Saudi Arabia
| | - Kim Lewis
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
| | - Mohammed Badawee
- Department of Critical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Waleed Alhazzani
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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5
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Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, Zein A, Khatani N, Al-Hameed F, Alamri S, Abdelzaher M, Alghamdi A, Alfousan F, Tash A, Tashkandi W, Alraddadi R, Lewis K, Badawee M, Arabi YM, Fan E, Alhazzani W. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care 2018. [PMID: 29330690 DOI: 10.1186/s13613-017-0350-x.pmid:29330690;pmcid:pmc5768582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.
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Affiliation(s)
- Mohammed S Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, PO Box 40236, Al Khobar, 31952, Saudi Arabia.
| | - Anees Sindi
- Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Awad Al-Omari
- Medical Director of Critical Care, Dr. Suliman Al-Habib Group, AlFaisal University, Riyadh, Saudi Arabia
| | - Mohamed El Tahan
- Department of Anesthesiology, Dammam University, Dammam, Saudi Arabia
| | | | - Ahmed Zein
- Department of ICU, King Fahad Hospital, Jeddah, Saudi Arabia
| | | | - Fahad Al-Hameed
- King Abdulaziz Medical City, NGHA, Jeddah, Saudi Arabia
- Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sultan Alamri
- Department of ICU National Hospital, Internal Medicine and Critical Care, Riyadh, Saudi Arabia
| | | | - Amenah Alghamdi
- Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal Alfousan
- Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Tash
- Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Wail Tashkandi
- Department of Surgery/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rajaa Alraddadi
- Community Medicine Department, Ministry of Health, Jeddah, Saudi Arabia
| | - Kim Lewis
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
| | - Mohammed Badawee
- Department of Critical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Waleed Alhazzani
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Menon N, Perez-Velez CM, Wheeler JA, Morris MF, Amabile OL, Tasset MR, Raschke RA. Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season. Rev Bras Ter Intensiva 2017; 29:271-278. [PMID: 28977101 PMCID: PMC5632968 DOI: 10.5935/0103-507x.20170048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/15/2017] [Indexed: 01/19/2023] Open
Abstract
Objective This report aimed to describe the outcomes of the patients with severe H1N1
associated acute respiratory distress syndrome who were treated with
extracorporeal membrane oxygenation therapy. Methods This retrospective review analyzed a single-center cohort of adult patients
with H1N1-related acute respiratory distress syndrome who were managed with
veno-venous extracorporeal membrane oxygenation during the winter of
2013/2014. Results A total of 10 patients received veno-venous extracorporeal membrane
oxygenation for H1N1 influenza between January 2013 and March 2014. Seven
patients were transferred to our center for extracorporeal membrane
oxygenation consideration (all within 72 hours of initiating mechanical
ventilation). The median patient age was forty years, and 30% were female.
The median arterial oxygen partial pressure to fraction of inspired oxygen
ratio was 62.5, and the median RESP score was 6. Three patients received
inhaled nitric oxide, and four patients were proned as rescue therapy before
extracorporeal membrane oxygenation was initiated. The median duration of
mechanical ventilation was twenty-two days (range, 14 - 32). The median
length of stay in the intensive care unit was twenty-seven days (range, 14 -
39). The median hospital length of stay was 29.1 days (range, 16.0 - 46.9).
Minor bleeding complications occurred in 6 of 10 patients. Eight of the ten
patients survived to hospital discharge. Conclusion The survivors were relatively young and discharged with good functional
status (i.e., enhancing quality-adjusted life-years-saved). Our experience
shows that even a relatively new extracorporeal membrane oxygenation program
can play an important role in that capacity and provide excellent outcomes
for the sickest patients.
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Affiliation(s)
- Nithya Menon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Banner - University Medical Center Phoenix - Arizona, United States
| | - Carlos M Perez-Velez
- Division of Infectious Diseases, Department of Medicine, Banner - University Medical Center Phoenix - Arizona, United States
| | - Jennifer A Wheeler
- Division of Cardiothoracic Surgery, Department of Surgery, Banner - University Medical Center Phoenix - Arizona, United States
| | - Michael F Morris
- Division of Thoracic Radiology, Department of Radiology, Banner - University Medical Center Phoenix - Arizona, United States
| | - Orazio L Amabile
- Division of Cardiothoracic Surgery, Department of Surgery, Banner - University Medical Center Phoenix - Arizona, United States
| | - Mark R Tasset
- Division of Cardiothoracic Surgery, Department of Surgery, Banner - University Medical Center Phoenix - Arizona, United States
| | - Robert A Raschke
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Banner - University Medical Center Phoenix - Arizona, United States
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Díez F, Sousa I, Juárez M, Díez-Villanueva P, Elízaga J, Fernández-Avilés F. Resucitación cardiopulmonar mediante ECMO percutáneo: una nueva herramienta en el laboratorio de hemodinámica. Med Intensiva 2015; 39:251-3. [DOI: 10.1016/j.medin.2014.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/05/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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Schmidt M, Hodgson C, Combes A. Extracorporeal gas exchange for acute respiratory failure in adult patients: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:99. [PMID: 25887146 PMCID: PMC4484573 DOI: 10.1186/s13054-015-0806-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Matthieu Schmidt
- Université Pierre et Marie Curie, Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Carol Hodgson
- The Australian & New Zealand Intensive Care Research Centre and the Intensive Care Department, Alfred Hospital, Melbourne, Australia.
| | - Alain Combes
- Université Pierre et Marie Curie, Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Tramm R, Ilic D, Davies AR, Pellegrino VA, Romero L, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev 2015; 1:CD010381. [PMID: 25608845 PMCID: PMC6353247 DOI: 10.1002/14651858.cd010381.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs. Extracorporeal membrane oxygenation for severe respiratory failure accesses and returns blood from the venous system and provides non-pulmonary gas exchange. Extracorporeal membrane oxygenation for severe cardiac failure or for refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic circulation. The configuration of ECMO is variable, and several pump-driven and pump-free systems are in use. Use of ECMO is associated with several risks. Patient-related adverse events include haemorrhage or extremity ischaemia; circuit-related adverse effects may include pump failure, oxygenator failure and thrombus formation. Use of ECMO in newborns and infants is well established, yet its clinical effectiveness in adults remains uncertain. OBJECTIVES The primary objective of this systematic review was to determine whether use of veno-venous (VV) or venous-arterial (VA) ECMO in adults is more effective in improving survival compared with conventional respiratory and cardiac support. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 18 August 2014. We searched conference proceedings, meeting abstracts, reference lists of retrieved articles and databases of ongoing trials and contacted experts in the field. We imposed no restrictions on language or location of publications. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs and cluster-RCTs that compared adult ECMO versus conventional support. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of all retrieved citations against the inclusion criteria. We independently reviewed full-text copies of studies that met the inclusion criteria. We entered all data extracted from the included studies into Review Manager. Two review authors independently performed risk of bias assessment. All included studies were appraised with respect to random sequence generation, concealment of allocation, blinding of outcome assessment, incomplete outcome data, selective reporting and other bias. MAIN RESULTS We included four RCTs that randomly assigned 389 participants with acute respiratory failure. Risk of bias was low in three RCTs and high in one RCT. We found no statistically significant differences in all-cause mortality at six months (two RCTs) or before six months (during 30 days of randomization in one trial and during hospital stay in another RCT). The quality of the evidence was low to moderate, and further research is very likely to impact our confidence in the estimate of effects because significant changes have been noted in ECMO applications and treatment modalities over study periods to the present.Two RCTs supplied data on disability. In one RCT survival was low in both groups but none of the survivors had limitations in their daily activities six months after discharge. The other RCT reported improved survival without severe disability in the intervention group (transfer to an ECMO centre ± ECMO) six months after study randomization but no statistically significant differences in health-related quality of life.In three RCTs, participants in the ECMO group received greater numbers of blood transfusions. One RCT recorded significantly more non-brain haemorrhage in the ECMO group. Another RCT reported two serious adverse events in the ECMO group, and another reported three adverse events in the ECMO group.Clinical heterogeneity between studies prevented meta-analyses across outcomes. We found no completed RCT that had investigated ECMO in the context of cardiac failure or arrest. We found one ongoing RCT that examined patients with acute respiratory failure and two ongoing RCTs that included patients with acute cardiac failure (arrest). AUTHORS' CONCLUSIONS Extracorporeal membrane oxygenation remains a rescue therapy. Since the year 2000, patient treatment and practice with ECMO have considerably changed as the result of research findings and technological advancements over time. Over the past four decades, only four RCTs have been published that compared the intervention versus conventional treatment at the time of the study. Clinical heterogeneity across these published studies prevented pooling of data for a meta-analysis.We recommend combining results of ongoing RCTs with results of trials conducted after the year 2000 if no significant shifts in technology or treatment occur. Until these new results become available, data on use of ECMO in patients with acute respiratory failure remain inconclusive. For patients with acute cardiac failure or arrest, outcomes of ongoing RCTs will assist clinicians in determining what role ECMO and ECPR can play in patient care.
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Affiliation(s)
- Ralph Tramm
- Monash UniversityAustralian and New Zealand Intensive Care Research Centre (ANZIC‐RC), Department of Epidemiology and Preventive MedicineLevel 6 The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Dragan Ilic
- Monash UniversityDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine553 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Andrew R Davies
- Monash UniversityAustralian and New Zealand Intensive Care Research Centre (ANZIC‐RC), Department of Epidemiology and Preventive MedicineLevel 6 The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Vincent A Pellegrino
- The Alfred HospitalDepartment of Intensive CareCommercial RoadMelbourneAustralia3181
| | - Lorena Romero
- The Alfred HospitalThe Ian Potter Library55 Commercial RoadMelbourneVictoriaAustralia3000
| | - Carol Hodgson
- Monash UniversityAustralian and New Zealand Intensive Care Research Centre (ANZIC‐RC), Department of Epidemiology and Preventive MedicineLevel 6 The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
- The Alfred HospitalDepartment of PhysiotherapyMelbourneAustralia
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Combes A, Brodie D, Bartlett R, Brochard L, Brower R, Conrad S, De Backer D, Fan E, Ferguson N, Fortenberry J, Fraser J, Gattinoni L, Lynch W, MacLaren G, Mercat A, Mueller T, Ogino M, Peek G, Pellegrino V, Pesenti A, Ranieri M, Slutsky A, Vuylsteke A. Position Paper for the Organization of Extracorporeal Membrane Oxygenation Programs for Acute Respiratory Failure in Adult Patients. Am J Respir Crit Care Med 2014; 190:488-96. [DOI: 10.1164/rccm.201404-0630cp] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Kim SJ, Jeon YB, Seo YH, Jeong SH, Park JW, Shin J, Kim YJ. Successful Treatment in Fatal Adenovirus Pneumonia with the Use of Extracorporeal Membrane Oxygenation. ACTA ACUST UNITED AC 2014. [DOI: 10.15746/sms.14.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Choi WS, Baek JH, Seo YB, Kee SY, Jeong HW, Lee HY, Eun BW, Choo EJ, Lee J, Kim YK, Song JY, Wie SH, Lee JS, Cheong HJ, Kim WJ. Severe influenza treatment guideline. Korean J Intern Med 2014; 29:132-47. [PMID: 24574848 PMCID: PMC3932389 DOI: 10.3904/kjim.2014.29.1.132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 01/20/2023] Open
Affiliation(s)
- Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yu Bin Seo
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Sae Yoon Kee
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hee Young Lee
- Gachon University Gil Hospital Cancer Center, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea
| | - Eun Ju Choo
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jacob Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Résultats de l’assistance respiratoire extracorporelle dans les syndromes de détresse respiratoire aiguë sévères. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-014-0874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zampieri FG, Mendes PV, Ranzani OT, Taniguchi LU, Pontes Azevedo LC, Vieira Costa EL, Park M. Extracorporeal membrane oxygenation for severe respiratory failure in adult patients: a systematic review and meta-analysis of current evidence. J Crit Care 2013; 28:998-1005. [PMID: 23954453 DOI: 10.1016/j.jcrc.2013.07.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/07/2013] [Accepted: 07/08/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) for acute respiratory failure is still a matter of debate. METHODS We performed a structured search on Pubmed, EMBASE, Lilacs, and the Cochrane Library for randomized controlled trials and observational case-control studies with severity-paired patients, evaluating the use of ECMO on severe acute respiratory failure in adult patients. A random-effect model using DerSimonian and Laird method for variance estimator was performed to evaluate the effect of ECMO use on hospital mortality. Heterogeneity between studies was assessed with Cochran's Q statistic and Higgin's I(2). RESULTS Three studies were included on the metanalysis, comprising 353 patients in the main analysis, in which 179 patients were ECMO supported. One study was a randomized controlled trial and two were observational studies with a propensity score matching. The most common reason for acute respiratory failure was influenza H1N1 pneumonia (45%) and pneumonia (33%). ECMO was not associated with a reduction in hospital mortality (OR = 0.71; CI 95% = 0.34 - 1.47; P = 0.358). If alternative severity-pairing method presented by the two observational studies was included, a total of 478 cases were included, in which 228 received ECMO support. In the former analysis, ECMO had a benefit on hospital mortality (OR = 0.52; CI 95% = 0.35 - 0.76; P < 0.001). CONCLUSION Extracorporeal membrane oxygenation benefit on hospital mortality is unclear. Results were sensitive to statistical analysis, and no definitive conclusion can be drawn from the available data. More studies are needed before the widespread use of ECMO can be recommended.
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Affiliation(s)
- Fernando Godinho Zampieri
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
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Estrategias frente a la hipoxemia refractaria en el síndrome de dificultad respiratoria del adulto. Med Intensiva 2013; 37:423-30. [DOI: 10.1016/j.medin.2012.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 11/27/2012] [Accepted: 12/13/2012] [Indexed: 11/20/2022]
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Torres A, Niederman MS, Artigas A, Carlet J. Pulmonary infections and resistance to antibiotics: recent information. Expert Rev Anti Infect Ther 2013. [PMID: 23199396 DOI: 10.1586/eri.12.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This yearly international meeting, 'Infections in the Critically Ill Patient' (3-4 February 2012, Barcelona, Spain) attended by 300 people from many different countries, was the 17th edition. This meeting gathers scientists from different horizons: microbiologists, infectious diseases specialists, intensivists and researchers in the fields of the meeting: sepsis, severe infections and pneumonia. This multidisciplinarity allows a rich cross-fertilization and outstanding discussions. This document summarizes the full day devoted to pulmonary infections and resistance to antibiotics.
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Affiliation(s)
- Antoni Torres
- Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome. Curr Opin Crit Care 2013; 19:38-43. [DOI: 10.1097/mcc.0b013e32835c2ac8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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