Zangrillo Alberto, Biondi-Zoccai Giuseppe, Landoni Giovanni, Frati Giacomo, Patroniti Nicolò, Pesenti Antonio, Pappalardo Federico
Crit Care. 2013 Feb 13;17(1):R30. doi: 10.1186/cc12512.
H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI.
CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus (updated 2 January 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods.
From 1,196 initial citations, 8 studies were selected, including 1,357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median Sequential Organ Failure Assessment (SOFA) score of 9, and had received mechanical ventilation before ECMO implementation for a median of two days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18% to 37%; I² = 64%).
ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (more than one week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death.
甲型H1N1流感可导致严重急性肺损伤（ALI）。体外膜肺氧合（ECMO）可支持常规机械通气失败患者的气体交换，但其作用仍存在争议。我们对ECMO治疗甲型H1N1流感相关ALI进行了系统评价和荟萃分析。
对CENTRAL、谷歌学术、MEDLINE/PubMed和Scopus（2012年1月2日更新）进行系统检索。纳入报告10例或更多接受ECMO治疗的甲型H1N1感染患者的研究。对基线、操作、结局和有效性数据进行系统评估，并在适当情况下采用随机效应方法进行汇总。
从1196条初始文献中筛选出8项研究，包括1357例确诊/疑似甲型H1N1感染且需要入住重症监护病房的患者，其中266例（20%）接受了ECMO治疗。患者序贯器官衰竭评估（SOFA）评分中位数为9分，在实施ECMO前接受机械通气的中位数为2天。72%的病例在院际患者转运前植入了ECMO，大多数患者（94%）采用静脉-静脉模式。ECMO维持的中位数为10天。纳入研究的结局差异很大，住院或短期死亡率在8%至65%之间，主要取决于患者的基线特征。随机效应汇总估计显示总体住院死亡率为28%（95%置信区间18%至37%；I² = 64%）。
ECMO治疗甲型H1N1感染所致ALI患者是可行且有效的。尽管如此，大多数病例需要长期支持（超过一周），合并严重疾病或多器官衰竭的患者住院死亡风险仍然很高。
