Khan Muhammad Faisal, Nazir Mohsin, Khan Muhammad Khuzzaim, Rajendram Raj Kumar, Shamim Faisal
Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan.
Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
J Crit Care Med (Targu Mures). 2024 Apr 30;10(2):119-129. doi: 10.2478/jccm-2024-0017. eCollection 2024 Apr.
The utilization of extracorporeal membrane oxygenation (ECMO) in adult patients experiencing septic shock is a subject of ongoing debate within the medical community. This study aims to comprehensively address this issue through a systematic review conducted in accordance with the PRISMA guidelines.
The primary objective of this study is to assess the outcomes of ECMO utilization in adult patients diagnosed with septic shock, thereby providing insights into the potential benefits and uncertainties associated with this treatment modality.
Our research encompassed a thorough search across electronic databases for relevant English-language articles published up until April 2023. The inclusion criteria were based on studies reporting on ECMO usage in adult patients with septic shock. Among the eligible studies meeting these criteria, a total of eleven were included in our analysis, involving a cohort of 512 patients. The mean age of the participants was 53.4 years, with 67.38% being male.
In the pooled analysis, the mean survival rate following ECMO treatment was found to vary significantly across different ECMO modalities. Patients receiving venovenous-ECMO (VV-ECMO) and veno-venous-arterial ECMO (VVA-ECMO) demonstrated higher survival rates (44.5% and 44.4%, respectively) compared to those receiving venoarterial-ECMO (VA-ECMO) at 25% (p<0.05). A chi-square test of independence indicated that the type of ECMO was a significant predictor of survival (χ(2) = 6.63, p=0.036). Additionally, patients with septic shock stemming from respiratory failure demonstrated survival rates ranging from 39% to 70%. Predictors of mortality were identified as older age and the necessity for cardiopulmonary resuscitation (CPR).
In septic shock patients, ECMO outcomes align with established indications like respiratory and cardiogenic shock. VV-ECMO and VVA-ECMO suggest better prognoses, though the optimal mode remains uncertain. Patient selection should weigh age and CPR need. Further research is vital to determine ECMO's best approach for this population.
在患有感染性休克的成年患者中使用体外膜肺氧合（ECMO）是医学界持续争论的一个话题。本研究旨在根据PRISMA指南进行系统评价，全面解决这一问题。
本研究的主要目的是评估ECMO在诊断为感染性休克的成年患者中的应用结果，从而深入了解这种治疗方式的潜在益处和不确定性。
我们的研究全面检索了电子数据库，以查找截至2023年4月发表的相关英文文章。纳入标准基于报告ECMO在成年感染性休克患者中使用情况的研究。在符合这些标准的合格研究中，共有11项被纳入我们的分析，涉及512名患者队列。参与者的平均年龄为53.4岁，男性占67.38%。
在汇总分析中，发现ECMO治疗后的平均生存率在不同的ECMO模式下有显著差异。接受静脉-静脉ECMO（VV-ECMO）和静脉-静脉-动脉ECMO（VVA-ECMO）的患者生存率较高（分别为44.5%和44.4%），而接受静脉-动脉ECMO（VA-ECMO）的患者生存率为25%（p<0.05）。独立性卡方检验表明，ECMO类型是生存的显著预测因素（χ(²) = 6.63，p = 0.036）。此外，因呼吸衰竭导致感染性休克的患者生存率在39%至70%之间。死亡率的预测因素被确定为年龄较大和需要心肺复苏（CPR）。
在感染性休克患者中，ECMO的结果与呼吸和心源性休克等既定适应症相符。VV-ECMO和VVA-ECMO提示预后较好，尽管最佳模式仍不确定。患者选择应权衡年龄和CPR需求。进一步的研究对于确定ECMO针对该人群的最佳方法至关重要。
