Department of Intensive Care Medicine, No.903 Hospital of PLA Joint Logistic Support Force, Hangzhou, China.
BMC Pulm Med. 2024 Oct 10;24(1):504. doi: 10.1186/s12890-024-03321-1.
Extracorporeal membrane oxygenation (ECMO) is increasingly employed to support lung function in patients with acute respiratory failure (ARF). However, the long-term outcomes of the approach have not been encouraging when compared to those of conventional mechanical ventilation. Further, the long-term effects of ECMO on lung function and recovery are unclear. For this review, we examined the long-term lung function outcomes of patients with ARF treated with and without ECMO.
We searched the Embase, CENTRAL, Web of Science, and PubMed sites for studies comparing long-term (≥ 6 months) pulmonary function test results in patients with ARF treated with and without ECMO published until January 2024. We conducted a meta-analysis for percentage predicted values.
We included five studies. Our meta-analysis showed similar values of forced vital capacity (FVC%) (MD, 0.47; 95% CI, -3.56-4.50) and forced expiratory flow in the first second % (MD, 1.79; 95% CI, -2.17-5.75) in patients with ARF treated with or without ECMO. The FEV1/FVC % values were slightly higher in patients treated with ECMO than in those without ECMO (MD, 2.03; 95% CI, 0.01-4.04; p-value = 0.05). According to the meta-analysis, the values for total lung capacity % (MD, -3.20; 95% CI, -8.83-2.44) and carbon monoxide diffusion capacity % (MD, -0.72; 95% CI, -3.83-2.39) were also similar between patients undergoing ECMO and those without it.
The meta-analysis of a small number of studies with significant selection bias indicates that patients with ARF treated with ECMO may have comparable long-term pulmonary function recovery to those treated with conventional strategies. Further investigations including a larger number of patients and focusing on the long-term impact of ECMO are needed to supplement the current evidence.
体外膜肺氧合（ECMO）越来越多地用于支持急性呼吸衰竭（ARF）患者的肺功能。然而，与传统机械通气相比，其长期效果并不理想。此外，ECMO 对肺功能和恢复的长期影响尚不清楚。在本次综述中，我们研究了接受 ECMO 和未接受 ECMO 治疗的 ARF 患者的长期肺功能结局。
我们在 Embase、CENTRAL、Web of Science 和 PubMed 网站上检索了截至 2024 年 1 月比较接受 ECMO 和未接受 ECMO 治疗的 ARF 患者长期（≥6 个月）肺功能检测结果的研究。我们对百分比预计值进行了荟萃分析。
我们纳入了 5 项研究。我们的荟萃分析显示，接受 ECMO 和未接受 ECMO 治疗的 ARF 患者的用力肺活量（FVC%）（MD，0.47；95%CI，-3.56-4.50）和 1 秒用力呼气量（FEV1）%（MD，1.79；95%CI，-2.17-5.75）值相似。与未接受 ECMO 治疗的患者相比，接受 ECMO 治疗的患者的 FEV1/FVC% 值略高（MD，2.03；95%CI，0.01-4.04；p 值=0.05）。根据荟萃分析，总肺容量（TLC）%（MD，-3.20；95%CI，-8.83-2.44）和一氧化碳弥散量（DLCO）%（MD，-0.72；95%CI，-3.83-2.39）值在接受 ECMO 和未接受 ECMO 治疗的患者之间也相似。
对存在显著选择偏倚的少数研究进行荟萃分析表明，接受 ECMO 治疗的 ARF 患者的长期肺功能恢复可能与接受传统策略治疗的患者相当。需要进一步进行包括更多患者的研究，并关注 ECMO 的长期影响，以补充现有证据。
