体外膜肺氧合对心源性休克患者死亡率的影响：基于观察性研究的系统评价和试验序贯荟萃分析。
Impact of awake extracorporeal membrane oxygenation on patients mortality with cardiogenic shock: a systematic review and trial sequential meta-analysis based on observational studies.
机构信息
Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Sichuan Provincial Research Center for Emergency Medicine and Critical illness, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
BMJ Open. 2024 Oct 29;14(10):e086383. doi: 10.1136/bmjopen-2024-086383.
OBJECTIVES
The use of awake extracorporeal membrane oxygenation (ECMO, without intubation or sedation under ECMO support in patients with cardiogenic shock is growing rapidly because emerging clinical investigations indicates it may reduce morbidity associated with sedation and intubation. We systematically reviewed the efficacy of awake ECMO and provided evidence for clinical practitioners and researchers.
DESIGN
Systematic review and trial sequential meta-analysis based on observational studies.
DATA SOURCES
Data was retrieved from seven databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database and Cochrane Library) up to 1 March 2024.
ELIGIBILITY CRITERIA
We included observational studies that compared the differences in clinical outcomes between awake ECMO and non-awake ECMO in patients with cardiogenic shock.
DATA EXTRACTION AND SYNTHESIS
Two reviewers rigorously conducted literature retrieval, screening and data extraction. The RevMan software was used for data synthesis.
RESULTS
Five retrospective observational studies involving 1044 patients with cardiogenic shock were included. Compared with non-awake ECMO, awake ECMO was associated with a lower mortality rate of patients with cardiogenic shock (OR=0.28; 95% CI, (0.15, 0.49); p<0.0001; I=50%). Trial sequential analysis indicated that the sample mortality outcome reached the required information size. No significant differences were observed between the two groups on secondary outcomes such as the occurrence of ventilator-associated pneumonia, weaning from ECMO, tracheostomy, haemorrhage, thrombosis, limb ischaemia and nosocomial infection.
CONCLUSIONS
Implementing awake ECMO may result in better clinical outcomes in patients with cardiogenic shock. Because of the limited sample sizes and potential bias of the current studies, more rigorously designed large-scale trials are urgently needed to verify the above findings.
PROSPERO REGISTRATION NUMBER
CRD42023407607.
目的
在心脏源性休克患者中使用清醒体外膜肺氧合（ECMO，在 ECMO 支持下无需插管或镇静）的应用正在迅速增长，因为新出现的临床研究表明，它可能降低与镇静和插管相关的发病率。我们系统地回顾了清醒 ECMO 的疗效，并为临床医生和研究人员提供了证据。
设计
基于观察性研究的系统评价和试验序贯荟萃分析。
数据来源
数据来自 7 个数据库（PubMed、Web of Science、Embase、中国知网、万方、中国生物医学文献数据库和 Cochrane 图书馆），检索时间截至 2024 年 3 月 1 日。
纳入标准
纳入比较心脏源性休克患者清醒 ECMO 与非清醒 ECMO 之间临床结局差异的观察性研究。
数据提取和综合
两位评审员严格进行文献检索、筛选和数据提取。RevMan 软件用于数据综合。
结果
纳入 5 项回顾性观察性研究，共纳入 1044 例心脏源性休克患者。与非清醒 ECMO 相比，清醒 ECMO 与心脏源性休克患者的死亡率较低相关（OR=0.28；95%CI，（0.15，0.49）；p<0.0001；I=50%）。试验序贯分析表明，样本死亡率结果达到了所需的信息量。两组在呼吸机相关性肺炎的发生、ECMO 脱机、气管切开术、出血、血栓形成、肢体缺血和医院感染等次要结局方面无显著差异。
结论
在心脏源性休克患者中实施清醒 ECMO 可能会带来更好的临床结局。由于目前研究的样本量有限且存在潜在偏倚，迫切需要更严格设计的大规模试验来验证上述发现。
前瞻性注册号
CRD42023407607。
Zotero 插件