接受静脉-动脉体外膜肺氧合治疗的急性肺栓塞患者的生存情况：一项系统评价和荟萃分析。
Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis.
作者信息
Karami Mina, Mandigers Loes, Miranda Dinis Dos Reis, Rietdijk Wim J R, Binnekade Jan M, Knijn Daniëlle C M, Lagrand Wim K, den Uil Corstiaan A, Henriques José P S, Vlaar Alexander P J
机构信息
Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
出版信息
J Crit Care. 2021 Aug;64:245-254. doi: 10.1016/j.jcrc.2021.03.006. Epub 2021 Mar 24.
BACKGROUND
To examine whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) improves survival of patients with acute pulmonary embolism (PE).
METHODS
Following the PRISMA guidelines, a systematic search was conducted up to August 2019 of the databases: PubMed/MEDLINE, EMBASE and Cochrane. All studies reporting the survival of adult patients with acute PE treated with VA-ECMO and including four patients or more were included. Exclusion criteria were: correspondences, reviews and studies in absence of a full text, written in other languages than English or Dutch, or dating before 1980. Short-term (hospital or 30-day) survival data were pooled and presented with relative risks (RR) and 95% confidence intervals (95% CI). Also, the following pre-defined factors were evaluated for their association with survival in VA-ECMO treated patients: age > 60 years, male sex, pre-ECMO cardiac arrest, surgical embolectomy, catheter directed therapy, systemic thrombolysis, and VA-ECMO as single therapy.
RESULTS
A total of 29 observational studies were included (N = 1947 patients: VA-ECMO N = 1138 and control N = 809). There was no difference in short-term survival between VA-ECMO treated patients and control patients (RR 0.91, 95% CI 0.71-1.16). In acute PE patients undergoing VA-ECMO, age > 60 years was associated with lower survival (RR 0.72, 95% CI 0.52-0.99), surgical embolectomy was associated with higher survival (RR 1.96, 95% CI 1.39-2.76) and pre-ECMO cardiac arrest showed a trend toward lower survival (RR 0.88, 95% CI 0.77-1.01). The other evaluated factors were not associated with a difference in survival.
CONCLUSIONS
At present, there is insufficient evidence that VA-ECMO treatment improves short-term survival of acute PE patients. Low quality evidence suggest that VA-ECMO patients aged ≤60 years or who received SE have higher survival rates. Considering the limited evidence derived from the present data, this study emphasizes the need for prospective studies.
PROTOCOL REGISTRATION
PROSPERO CRD42019120370.
背景
探讨静脉-动脉体外膜肺氧合（VA-ECMO）是否能提高急性肺栓塞（PE）患者的生存率。
方法
遵循PRISMA指南，截至2019年8月对以下数据库进行系统检索：PubMed/MEDLINE、EMBASE和Cochrane。纳入所有报告接受VA-ECMO治疗的成年急性PE患者生存率且患者数量不少于4例的研究。排除标准为：通信、综述以及无全文的研究、非英文或荷兰语撰写的研究，或1980年以前的研究。汇总短期（住院或30天）生存数据，并以相对风险（RR）和95%置信区间（95%CI）呈现。此外，评估以下预先定义的因素与接受VA-ECMO治疗患者生存率的相关性：年龄>60岁、男性、ECMO前心脏骤停、外科血栓切除术、导管定向治疗、全身溶栓以及VA-ECMO作为单一治疗方法。
结果
共纳入29项观察性研究（N = 1947例患者：VA-ECMO组N = 1138例，对照组N = 809例）。接受VA-ECMO治疗的患者与对照组患者的短期生存率无差异（RR 0.91，95%CI 0.71 - 1.16）。在接受VA-ECMO治疗的急性PE患者中，年龄>60岁与较低的生存率相关（RR 0.72，95%CI 0.52 - 0.99），外科血栓切除术与较高的生存率相关（RR 1.96，95%CI 1.39 - 2.76），ECMO前心脏骤停显示出生存率降低的趋势（RR 0.88，95%CI 0.77 - 1.01）。其他评估因素与生存率差异无关。
结论
目前，没有足够的证据表明VA-ECMO治疗能提高急性PE患者的短期生存率。低质量证据表明，年龄≤60岁或接受外科血栓切除术的VA-ECMO患者生存率较高。鉴于现有数据得出的证据有限，本研究强调需要进行前瞻性研究。
方案注册
PROSPERO CRD42019120370。
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