Chiumello Davide, Coppola Silvia, Froio Sara, Colombo Andrea, Del Sorbo Lorenzo
Crit Care. 2015 Jan 22;19(1):19. doi: 10.1186/s13054-014-0686-7.
Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at a high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The aim of this study was to assess the current evidence regarding how the ECMO bridge influences patients' survival and length of hospital stay.
We performed a systematic review by searching PubMed, EMBASE and the bibliographies of retrieved articles. Three reviewers independently screened citation titles and abstracts and agreement was reached by consensus. We selected studies enrolling patients who received ECMO with the intention to bridge lung transplant. We included randomized controlled trials (RCTs), case-control studies and case series with ten or more patients. Outcomes of interest included survival and length of hospital stay. Quantitative data summaries were made when feasible.
We identified 82 studies, of which 14 were included in the final analysis. All 14 were retrospective studies which enrolled 441 patients in total. Because of the broad heterogeneity among the studies we did not perform a meta-analysis. The mortality rate of patients on ECMO before lung transplant and the one-year survival ranged from 10% to 50% and 50% to 90%, respectively. The intensive care and hospital length of stay ranged between a median of 15 to 47 days and 22 to 47 days, respectively. There was a general paucity of high-quality data and significant heterogeneity among studies in the enrolled patients and technology used, which confounded analysis.
In most of the studies, patients on ECMO while awaiting lung transplantation also received invasive mechanical ventilation. Therefore, whether ECMO as an alternative, rather than an adjunction, to invasive mechanical ventilation is a better bridging strategy to lung transplantation still remains an unresolved issue. ECMO support as a bridge for these patients could provide acceptable one-year survival. Future studies are needed to investigate ECMO as part of an algorithm of care for patients with end-stage lung disease.
在等待肺移植期间需要有创机械通气进行呼吸支持的急性呼吸衰竭患者死亡风险很高。体外膜肺氧合（ECMO）已被提议作为机械通气的一种替代桥接策略。本研究的目的是评估目前关于ECMO桥接如何影响患者生存和住院时间的证据。
我们通过检索PubMed、EMBASE以及检索到文章的参考文献进行了系统综述。三位评审员独立筛选文献标题和摘要，并通过共识达成一致意见。我们选择纳入了旨在桥接肺移植而接受ECMO治疗患者的研究。我们纳入了随机对照试验（RCT）、病例对照研究以及患者人数为10名或更多的病例系列研究。感兴趣的结局包括生存和住院时间。在可行的情况下进行了定量数据汇总。
我们识别出82项研究，其中14项纳入最终分析。所有14项均为回顾性研究，共纳入441例患者。由于研究之间存在广泛的异质性，我们未进行荟萃分析。肺移植前接受ECMO治疗患者的死亡率和一年生存率分别为10%至50%和50%至90%。重症监护和住院时间中位数分别在15至47天和22至47天之间。在纳入患者和所使用技术方面，普遍缺乏高质量数据且研究之间存在显著异质性，这混淆了分析。
在大多数研究中，等待肺移植期间接受ECMO治疗的患者也接受了有创机械通气。因此，ECMO作为有创机械通气的替代而非辅助手段是否是更好的肺移植桥接策略仍是一个未解决的问题。ECMO支持作为这些患者的桥接手段可提供可接受的一年生存率。未来需要开展研究，将ECMO作为终末期肺病患者护理方案的一部分进行调查。
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