Institute of Intensive Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland -
Institute of Biomedical Ethics and History of Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland.
Minerva Anestesiol. 2021 Feb;87(2):199-209. doi: 10.23736/S0375-9393.20.14513-9. Epub 2020 Aug 4.
The effectiveness of extracorporeal life support (ECLS) in critically ill patients remains unclear despite a substantial increase in its use. This study critically assesses existing ECLS guidelines, consensus statements, and position papers to systematically review them for agreements and differences regarding indications and contraindications for ECLS.
The aims of this review were to identify available indications and contraindications for ECLS and to evaluate the quality of the evidence on which they are based. Documents containing recommendations regarding indications and/or contraindications for ECLS in adults (aged 18+) were identified through Medline, EMBASE, and CENTRAL searches. Additional documents were identified from guideline-specific databases and the internet websites of professional societies. Based on the Appraisal of Guidelines for Research and Evaluation (AGREE II), four independent reviewers assessed the rigor of development and quality of the documents.
Eleven documents met the inclusion criteria. Three documents received an average score of ≥50% in all domains. However, the Editorial independence domain only scored <50% in most of the documents. Overall, 13 cardiac and 13 pulmonary ECLS indications, and 23 cardiac and 14 pulmonary contraindications were identified. Indications and contraindications for ECLS use are variable across the documents included and leave considerable room for interpretation.
The documents included for review show considerable variability, with little consensus on indications and contraindications. This lack of consensus may reflect a lack of clarity regarding ECLS utility. Additionally, it may reveal the necessity for individualized, patient-dependent criteria supported by the best evidence available.
尽管体外生命支持（ECLS）的使用量大幅增加，但在危重病患者中的有效性仍不清楚。本研究批判性地评估了现有的 ECLS 指南、共识声明和立场文件，系统地审查了它们在 ECLS 适应证和禁忌证方面的一致性和差异。
本综述的目的是确定 ECLS 的现有适应证和禁忌证，并评估其依据的证据质量。通过 Medline、EMBASE 和 CENTRAL 搜索，确定了包含成人（18 岁及以上）ECLS 适应证和/或禁忌证建议的文件。还从指南特定数据库和专业协会的互联网网站中确定了其他文件。根据评估指南研究与评价（AGREE II），四位独立评审员评估了文件制定的严谨性和质量。
符合纳入标准的文件有 11 份。三份文件在所有领域的平均得分均≥50%。然而，编辑独立性领域在大多数文件中的得分均<50%。总体而言，确定了 13 项心脏和 13 项肺 ECLS 适应证，以及 23 项心脏和 14 项肺 ECLS 禁忌证。纳入的文件中 ECLS 使用的适应证和禁忌证各不相同，有很大的解释空间。
本综述纳入的文件显示出相当大的差异，在适应证和禁忌证方面几乎没有共识。这种缺乏共识可能反映了对 ECLS 效用的认识不明确。此外，这可能表明需要个体化、基于患者的、由最佳现有证据支持的标准。
