Zaki Hany A, Yigit Yavuz, Elgassim Mohamed, Shaban Eman E, Shaban Amira, Lloyd Stuart A, Mohamed Mazin Sharafeldien Elsayed, Azad Aftab Mohammad
Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
Bull Emerg Trauma. 2024;12(3):103-110. doi: 10.30476/beat.2024.102203.1503.
The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.
From inception until April 30, 2024, an extensive search was performed on four main databases: PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Only the studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLS in the treatment of intoxicated patients were included. On the other hand, articles that did not report adverse events or hospital discharge rates as outcomes, as well as studies published in languages other than English, were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidence of adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise each study to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version 3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among the studies) and a 95% confidence interval.
From a total search of 2216 search results, only 10 studies were included. The pooled analysis from 10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated with a significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], =0.030). However, the outcomes were highly heterogeneous (I=83.47%), which could be attributed to the use of several medicines by different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with a significant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], =0.002). However, the pooled analysis had a significant heterogeneity (I=70.27%).
Despite various health complications, extracorporeal membrane treatment enhanced survival to hospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternative for managing drug-induced intoxication in patients.
本研究旨在评估对药物中毒患者实施体外膜肺氧合/体外生命支持（ECMO/ECLS）治疗的临床益处和弊端。
从研究开始至2024年4月30日，对四个主要数据库进行了广泛检索：PubMed、科学网、考克兰图书馆和EMBASE。检索期无限制。仅纳入报告了中毒患者住院生存率、不良事件以及ECMO/ECLS使用情况的研究。另一方面，未将不良事件或出院率作为结果报告的文章，以及非英文发表的研究均被排除。评估的结果为出院生存率和与ECMO治疗相关的不良事件发生率。采用纽卡斯尔渥太华量表评估每项研究以确定其方法学质量。使用综合荟萃分析（CMA）软件（版本3.0）进行统计分析，采用随机效应模型（由于研究间异质性高）和95%置信区间。
在总共2216条检索结果中，仅纳入了10项研究。10项研究的汇总分析表明，药物过量/中毒患者接受ECMO治疗后，出院生存率显著为65.6%（[95%置信区间：51.5%-77.4%]，P = 0.030）。然而，结果具有高度异质性（I² = 83.47%），这可能归因于不同研究使用了多种药物。相比之下，药物过量患者接受ECMO治疗后，不良事件发生率显著为23.1%（[95%置信区间：12.3%-39.2%]，P = 0.002）。然而，汇总分析存在显著异质性（I² = 70.27%）。
尽管存在各种健康并发症，但体外膜肺治疗提高了出院生存率，且神经功能结局良好。因此，它是治疗患者药物中毒的一种可行、有效且可行的替代方法。
