Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
University Library, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Crit Care. 2024 Apr 30;28(1):146. doi: 10.1186/s13054-024-04927-x.
A systematic review and meta-analysis to evaluate the impact of extracorporeal carbon dioxide removal (ECCOR) on gas exchange and respiratory settings in critically ill adults with respiratory failure.
We conducted a comprehensive database search, including observational studies and randomized controlled trials (RCTs) from January 2000 to March 2022, targeting adult ICU patients undergoing ECCOR. Primary outcomes were changes in gas exchange and ventilator settings 24 h after ECCOR initiation, estimated as mean of differences, or proportions for adverse events (AEs); with subgroup analyses for disease indication and technology. Across RCTs, we assessed mortality, length of stay, ventilation days, and AEs as mean differences or odds ratios.
A total of 49 studies encompassing 1672 patients were included. ECCOR was associated with a significant decrease in PaCO, plateau pressure, and tidal volume and an increase in pH across all patient groups, at an overall 19% adverse event rate. In ARDS and lung transplant patients, the PaO/FiO ratio increased significantly while ventilator settings were variable. "Higher extraction" systems reduced PaCO and respiratory rate more efficiently. The three available RCTs did not demonstrate an effect on mortality, but a significantly longer ICU and hospital stay associated with ECCOR.
ECCOR effectively reduces PaCO and acidosis allowing for less invasive ventilation. "Higher extraction" systems may be more efficient to achieve this goal. However, as RCTs have not shown a mortality benefit but increase AEs, ECCOR's effects on clinical outcome remain unclear. Future studies should target patient groups that may benefit from ECCOR. PROSPERO Registration No: CRD 42020154110 (on January 24, 2021).
系统评价和荟萃分析评估体外二氧化碳去除（ECCOR）对呼吸衰竭重症成人气体交换和呼吸设置的影响。
我们进行了全面的数据库检索，包括 2000 年 1 月至 2022 年 3 月期间的观察性研究和随机对照试验（RCT），针对接受 ECCOR 的成人 ICU 患者。主要结局是 ECCOR 启动后 24 小时气体交换和呼吸机设置的变化，以平均值差异或不良事件（AE）的比例表示；按疾病指征和技术进行亚组分析。在 RCT 中，我们评估了死亡率、住院时间、通气天数和 AE，以平均值差异或比值比表示。
共纳入 49 项研究，共 1672 例患者。ECCOR 与所有患者群体的 PaCO2、平台压和潮气量显著降低以及 pH 值升高有关，总体不良事件发生率为 19%。在 ARDS 和肺移植患者中，PaO/FiO 比值显著增加，而呼吸机设置则有所不同。“高提取”系统更有效地降低 PaCO2 和呼吸频率。三项可用的 RCT 并未显示对死亡率有影响，但与 ECCOR 相关的 ICU 和住院时间明显延长。
ECCOR 有效降低 PaCO2 和酸中毒，从而实现更微创的通气。“高提取”系统可能更有效地实现这一目标。然而，由于 RCT 并未显示出死亡率获益，但增加了 AE，ECCOR 对临床结果的影响仍不清楚。未来的研究应针对可能从 ECCOR 中获益的患者群体。PROSPERO 注册号：CRD 42020154110（2021 年 1 月 24 日）。
