Extracorporeal Circulation During Lung Transplantation Procedures: A Meta-Analysis
Extracorporeal Circulation During Lung Transplantation Procedures: A Meta-Analysis
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DOI：
10.1097/mat.0000000000000549
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发表时间：
2017-09-01
期刊：
影响因子：
4.2
通讯作者：
von Dossow, Vera
中科院分区：
文献类型：
--
作者：
Hoechter, Dominik J.;Shen, Yu-Ming;von Dossow, Vera
体外循环(ECC)是肺移植(LUTX)的重要手段。在过去的几年里，越来越多的中心将术中ECC的标准从体外循环(CPB)改为体外膜氧合(ECMO)-结果不同。这项荟萃分析回顾了现有的证据。对Medline、Embase和PubMed进行了在线文学研究。两个人使用Cochrane协作的Acrobat-NRSI工具独立评判论文。使用Meta分析和Meta回归分析来确定静脉-动脉ECMO(VA-ECMO)是否比CPB有更好的结果。分析中包括六篇论文--所有未随机进行的观察性研究。作为联合干预，所有患者均被认为存在肝素化引起的严重偏倚。森林小区显示ECMO在输血方面的有利趋势(红细胞平均差值为-0.46单位[95%CI=-3.72，2.80]，新鲜冷冻血浆平均差值为-0.65单位[95%CI=-1.56，0.25]，血小板平均差值为-1.72单位[95%CI=-3.67，0.23])。ECMO患者的呼吸机支持时间平均差为-2.86天[95%CI=-11.43，5.71]，ICU住院时间平均差-4.79天[95%CI=-8.17，-1.41]。3个月病死率(优势比=0.46，95%CI=0.21~1.02)和1年病死率(优势比=0.65，95%CI=0.37~1.13)优于体外膜肺氧合治疗。然而，只有ICU的住院时间达到统计学意义。Meta回归分析表明，不同研究的异质性(性别、实施ECMO的年份和潜在疾病)影响差异。这些数据表明，与CPB相比，在肺移植手术中使用ECMO在短期结果(ICU停留时间)方面是有好处的。在输血需求或长期结果方面，没有统计上的显著影响。ECMO在LUTX患者中的优越性有待于更大规模的多中心随机试验来确定。
Extracorporeal circulation (ECC) is an invaluable tool in lung transplantation (lutx). More than the past years, an increasing number of centers changed their standard for intraoperative ECC from cardiopulmonary bypass (CPB) to extracorporeal membrane oxygenation (ECMO) - with differing results. This meta-analysis reviews the existing evidence. An online literature research on Medline, Embase, and PubMed has been performed. Two persons independently judged the papers using the ACROBAT-NRSI tool of the Cochrane collaboration. Meta-analyses and meta-regressions were used to determine whether veno-arterial ECMO (VA-ECMO) resulted in better outcomes compared with CPB. Six papers - all observational studies without randomization -were included in the analysis. All were considered to have serious bias caused by heparinization as co-intervention. Forest plots showed a beneficial trend of ECMO regarding blood transfusions (packed red blood cells (RBCs) with an average mean difference of -0.46 units [95% CI = -3.72, 2.80], fresh-frozen plasma with an average mean difference of -0.65 units [95% CI = -1.56, 0.25], platelets with an average mean difference of -1.72 units [95% CI = -3.67, 0.23]). Duration of ventilator support with an average mean difference of -2.86 days [95% CI = -11.43, 5.71] and intensive care unit (ICU) length of stay with an average mean difference of -4.79 days [95% CI = -8.17, -1.41] were shorter in ECMO patients. Extracorporeal membrane oxygenation treatment tended to be superior regarding 3 month mortality (odds ratio = 0.46, 95% CI = 0.21-1.02) and 1 year mortality (odds ratio = 0.65, 95% CI = 0.37-1.13). However, only the ICU length of stay reached statistical significance. Meta-regression analyses showed that heterogeneity across studies (sex, year of ECMO implementation, and underlying disease) influenced differences. These data indicate a benefit of the intraoperative use of ECMO as compared with CPB during lung transplant procedures regarding short-term outcome (ICU stay). There was no statistically significant effect regarding blood transfusion needs or long-term outcome. The superiority of ECMO in lutx patients rem-ins to be determined in larger multi-center randomized trials.