A Systematic Review and Meta-Analysis of Extracorporeal Membrane Oxygenation in Patients with Burns.
A Systematic Review and Meta-Analysis of Extracorporeal Membrane Oxygenation in Patients with Burns.
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DOI：
10.1097/prs.0000000000009149
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发表时间：
2022-06-01
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
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作者：
严重烧伤患者发生心肺衰竭的风险很高。有希望的研究激发了使用体外膜氧合作为烧伤患者难治性心脏和/或呼吸衰竭的潜在治疗方法的兴趣。然而，之前的研究结果各不相同。在这项研究中，作者使用标准化死亡率进行了系统回顾和荟萃分析，以阐明在烧伤和/或吸入性损伤患者中使用体外膜氧合的益处。进行文献检索，并比较所选研究的临床结果。荟萃分析发现，接受体外膜氧合的患者观察到的死亡率明显高于预测的死亡率（标准化死亡率，2.07;95% CI, 1.04 ~ 4.14）。然而，合并吸入性损伤的烧伤患者亚组的死亡率低于其预测死亡率（标准化死亡率，0.95;95% CI， 0.52至1.73）。其他亚组分析报告体外膜氧合无益处；然而，这些结果没有统计学意义。有趣的是，随着所选患者修订Baux评分的增加，合并标准化死亡率值下降（R = - 0.92），表明治疗的潜在益处随着烧伤患者严重程度的增加而增加。作者的荟萃分析显示，接受体外膜氧合治疗的烧伤患者死亡风险更高。然而，一些特定的患者，包括吸入性损伤患者和Baux评分超过90分的患者，将从治疗中受益。作者建议，合并吸入性损伤或Baux评分超过90分的烧伤患者应考虑治疗并尽早转移到体外膜氧合中心。
Severely burned patients are at high risk for cardiopulmonary failure. Promising studies have stimulated interest in using extracorporeal membrane oxygenation as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. However, the findings from previous studies vary. In this study, the authors conducted a systematic review and meta-analysis using standardized mortality ratios to elucidate the benefits associated with the use of extracorporeal membrane oxygenation in patients with burn and/or inhalation injuries. A literature search was performed, and clinical outcomes in the selected studies were compared. The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving extracorporeal membrane oxygenation (standardized mortality ratio, 2.07; 95 percent CI, 1.04 to 4.14). However, the subgroup of burn patients with inhalation injuries had lower mortality rates compared to their predicted mortality rates (standardized mortality ratio, 0.95; 95 percent CI, 0.52 to 1.73). Other subgroup analyses reported no benefits from extracorporeal membrane oxygenation; however, these results were not statistically significant. Interestingly, the pooled standardized mortality ratio values decreased as the selected patients’ revised Baux scores increased (R = −0.92), indicating that the potential benefits from the treatment increased as the severity of patients with burns increased. The authors’ meta-analysis revealed that burn patients receiving extracorporeal membrane oxygenation treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with revised Baux scores over 90, would benefit from the treatment. The authors suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for the treatment and early transfer to an extracorporeal membrane oxygenation center.