Utilization and outcomes of extracorporeal CO 2 removal (ECCO 2 R): Systematic review and meta-analysis of arterio-venous and veno-venous ECCO 2 R approaches.

Autor: Yu TZ; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Tatum RT; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Saxena A; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Ahmad D; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Yost CC; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Maynes EJ; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., O'Malley TJ; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Massey HT; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Swol J; Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany., Whitson BA; Cardiac Surgery, Ohio State University, Columbus, Ohio, USA., Tchantchaleishvili V; Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Artificial organs [Artif Organs] 2022 May; Vol. 46 (5), pp. 763-774. Date of Electronic Publication: 2021 Dec 12.
DOI: 10.1111/aor.14130
Abstrakt: Introduction: Extracorporeal carbon dioxide removal (ECCO 2 R) provides respiratory support to patients suffering from hypercapnic respiratory failure by utilizing an extracorporeal shunt and gas exchange membrane to remove CO 2 from either the venous (VV-ECCO 2 R) or arterial (AV-ECCO 2 R) system before return into the venous site. AV-ECCO 2 R relies on the patient's native cardiac function to generate pressures needed to deliver blood through the extracorporeal circuit. VV-ECCO 2 R utilizes a mechanical pump and can be used to treat patients with inadequate native cardiac function. We sought to evaluate the existing evidence comparing the subgroups of patients supported on VV and AV-ECCO 2 R devices.
Methods: A literature search was performed to identify all relevant studies published between 2000 and 2019. Demographic information, medical indications, perioperative variables, and clinical outcomes were extracted for systematic review and meta-analysis.
Results: Twenty-five studies including 826 patients were reviewed. 60% of patients (497/826) were supported on VV-ECCO 2 R. The most frequent indications were acute respiratory distress syndrome (ARDS) [69%, (95%CI: 53%-82%)] and chronic obstructive pulmonary disease (COPD) [49%, (95%CI: 37%-60%)]. ICU length of stay was significantly shorter in patients supported on VV-ECCO 2 R compared to AV-ECCO 2 R [15 (95%CI: 7-23) vs. 42 (95%CI: 17-67) days, p = 0.05]. In-hospital mortality was not significantly different [27% (95%CI: 18%-38%) vs. 36% (95%CI: 24%-51%), p = 0.26].
Conclusion: Both VV and AV-ECCO 2 R provided clinically meaningful CO 2 removal with comparable mortality.
(© 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.)
Databáze: MEDLINE
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