Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis.
Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis.
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DOI：
10.1093/burnst/tkac056
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发表时间：
2023
期刊：
影响因子：
5.3
通讯作者：
Li, Haisheng
中科院分区：
文献类型：
--
作者：
Heng, Xue;Cai, Peng;Yuan, Zhiqiang;Peng, Yizhi;Luo, Gaoxing;Li, Haisheng
呼吸和循环功能障碍是烧伤病人的常见并发症，也是烧伤病人死亡的主要原因，特别是在严重烧伤和吸入性损伤中。近年来，体外膜肺氧合（ECMO）越来越多地应用于烧伤患者。然而，目前的临床证据是薄弱和相互矛盾的。本研究旨在全面评价ECMO在烧伤患者中的有效性和安全性。对PubMed、Web of Science和Embase进行了从开始到2022年3月18日的全面检索，以识别烧伤患者ECMO的临床研究。主要结局是住院死亡率。次要结局包括成功脱离ECMO和ECMO相关并发症。采用Meta分析、Meta回归分析和亚组分析方法汇总临床疗效并确定影响因素。最终纳入了15项回顾性研究（318例患者），无任何对照组。最常见的ECMO适应症是严重急性呼吸窘迫综合征（42.1%）。静脉-静脉ECMO是最常见的模式（75.29%）。总人群的合并住院死亡率为49% [95%置信区间（CI）41-58%]，成人为55%，儿科为35%。荟萃回归和亚组分析发现，死亡率随着吸入性损伤的增加而显著增加，但随着ECMO持续时间的增加而降低。对于吸入性损伤百分比≥ 50%的研究，合并死亡率（55%，95% CI 40-70%）高于吸入性损伤百分比<50%的研究（32%，95% CI 18-46%）。对于ECMO持续时间≥10天的研究，合并死亡率（31%，95% CI 20-43%）低于ECMO持续时间<10天的研究（61%，95% CI 46-76%）。在轻度和重度烧伤中，合并死亡率低于重度烧伤。成功脱离ECMO的合并百分比为65%（95% CI 46-84%），与烧伤面积呈负相关。ECMO相关并发症的总发生率为67.46%，其中感染（30.77%）和眼睑（23.08%）是最常见的两种并发症。约49.26%的患者需要连续性肾脏替代治疗。尽管ECMO的死亡率和并发症发生率相对较高，但ECMO似乎是一种合适的烧伤患者抢救治疗方法。吸入性损伤、烧伤面积和ECMO持续时间是影响临床结局的主要因素。
Respiratory and circulatory dysfunction are common complications and the leading causes of death among burn patients, especially in severe burns and inhalation injury. Recently, extracorporeal membrane oxygenation (ECMO) has been increasingly applied in burn patients. However, current clinical evidence is weak and conflicting. This study aimed to comprehensively evaluate the efficacy and safety of ECMO in burn patients. A comprehensive search of PubMed, Web of Science and Embase from inception to 18 March 2022 was performed to identify clinical studies on ECMO in burn patients. The main outcome was in-hospital mortality. Secondary outcomes included successful weaning from ECMO and complications associated with ECMO. Meta-analysis, meta-regression and subgroup analyses were conducted to pool the clinical efficacy and identify influencing factors. Fifteen retrospective studies with 318 patients were finally included, without any control groups. The commonest indication for ECMO was severe acute respiratory distress syndrome (42.1%). Veno–venous ECMO was the commonest mode (75.29%). Pooled in-hospital mortality was 49% [95% confidence interval (CI) 41–58%] in the total population, 55% in adults and 35% in pediatrics. Meta-regression and subgroup analysis found that mortality significantly increased with inhalation injury but decreased with ECMO duration. For studies with percentage inhalation injury ≥50%, pooled mortality (55%, 95% CI 40–70%) was higher than in studies with percentage inhalation injury <50% (32%, 95% CI 18–46%). For studies with ECMO duration ≥10 days, pooled mortality (31%, 95% CI 20–43%) was lower than in studies with ECMO duration <10 days (61%, 95% CI 46–76%). In minor and major burns, pooled mortality was lower than in severe burns. Pooled percentage of successful weaning from ECMO was 65% (95% CI 46–84%) and inversely correlated with burn area. The overall rate of ECMO-related complications was 67.46%, and infection (30.77%) and bleedings (23.08%) were the two most common complications. About 49.26% of patients required continuous renal replacement therapy. ECMO seems to be an appropriate rescue therapy for burn patients despite the relatively high mortality and complication rate. Inhalation injury, burn area and ECMO duration are the main factors influencing clinical outcomes.
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