Heng Xue, Cai Peng, Yuan Zhiqiang, Peng Yizhi, Luo Gaoxing, Li Haisheng
Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Wei Fang City, Shan Dong Province, 261000, China.
Burns Trauma. 2023 Mar 1;11:tkac056. doi: 10.1093/burnst/tkac056. eCollection 2023.
Respiratory and circulatory dysfunction are common complications and the leading causes of death among burn patients, especially in severe burns and inhalation injury. Recently, extracorporeal membrane oxygenation (ECMO) has been increasingly applied in burn patients. However, current clinical evidence is weak and conflicting. This study aimed to comprehensively evaluate the efficacy and safety of ECMO in burn patients.
A comprehensive search of PubMed, Web of Science and Embase from inception to 18 March 2022 was performed to identify clinical studies on ECMO in burn patients. The main outcome was in-hospital mortality. Secondary outcomes included successful weaning from ECMO and complications associated with ECMO. Meta-analysis, meta-regression and subgroup analyses were conducted to pool the clinical efficacy and identify influencing factors.
Fifteen retrospective studies with 318 patients were finally included, without any control groups. The commonest indication for ECMO was severe acute respiratory distress syndrome (42.1%). Veno-venous ECMO was the commonest mode (75.29%). Pooled in-hospital mortality was 49% [95% confidence interval (CI) 41-58%] in the total population, 55% in adults and 35% in pediatrics. Meta-regression and subgroup analysis found that mortality significantly increased with inhalation injury but decreased with ECMO duration. For studies with percentage inhalation injury ≥50%, pooled mortality (55%, 95% CI 40-70%) was higher than in studies with percentage inhalation injury <50% (32%, 95% CI 18-46%). For studies with ECMO duration ≥10 days, pooled mortality (31%, 95% CI 20-43%) was lower than in studies with ECMO duration <10 days (61%, 95% CI 46-76%). In minor and major burns, pooled mortality was lower than in severe burns. Pooled percentage of successful weaning from ECMO was 65% (95% CI 46-84%) and inversely correlated with burn area. The overall rate of ECMO-related complications was 67.46%, and infection (30.77%) and bleedings (23.08%) were the two most common complications. About 49.26% of patients required continuous renal replacement therapy.
ECMO seems to be an appropriate rescue therapy for burn patients despite the relatively high mortality and complication rate. Inhalation injury, burn area and ECMO duration are the main factors influencing clinical outcomes.
呼吸和循环功能障碍是烧伤患者常见的并发症及主要死亡原因，尤其是在重度烧伤和吸入性损伤患者中。近年来，体外膜肺氧合（ECMO）在烧伤患者中的应用越来越多。然而，目前的临床证据薄弱且相互矛盾。本研究旨在全面评估ECMO在烧伤患者中的疗效和安全性。
对PubMed、Web of Science和Embase数据库从创建至2022年3月18日进行全面检索，以识别关于ECMO在烧伤患者中的临床研究。主要结局为住院死亡率。次要结局包括成功撤离ECMO以及与ECMO相关的并发症。进行荟萃分析、荟萃回归和亚组分析以汇总临床疗效并确定影响因素。
最终纳入15项回顾性研究，共318例患者，均无对照组。ECMO最常见的适应证是严重急性呼吸窘迫综合征（42.1%）。静脉-静脉ECMO是最常用的模式（75.29%）。总体住院死亡率在全部患者中为49%[95%置信区间（CI）41 - 58%]，成人中为55%，儿童中为35%。荟萃回归和亚组分析发现，死亡率随吸入性损伤显著增加，但随ECMO持续时间延长而降低。对于吸入性损伤百分比≥50%的研究，汇总死亡率（55%，95%CI 40 - 70%）高于吸入性损伤百分比<50%的研究（32%，95%CI 18 - 46%）。对于ECMO持续时间≥10天的研究，汇总死亡率（31%，95%CI 20 - 43%）低于ECMO持续时间<10天的研究（61%，95%CI 46 - 76%）。在轻度和中度烧伤患者中，汇总死亡率低于重度烧伤患者。成功撤离ECMO的汇总百分比为65%（95%CI 46 - 84%），且与烧伤面积呈负相关。ECMO相关并发症的总体发生率为67.46%，感染（30.77%）和出血（23.08%）是最常见的两种并发症。约49.26%的患者需要持续肾脏替代治疗。
尽管死亡率和并发症发生率相对较高，但ECMO似乎是烧伤患者合适的挽救治疗方法。吸入性损伤、烧伤面积和ECMO持续时间是影响临床结局的主要因素。
