Role of age as eligibility criterion for ECMO in patients with ARDS: meta-regression analysis.

Autor: Tonetti T; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy. tommaso.tonetti@unibo.it.; Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. tommaso.tonetti@unibo.it., Di Staso R; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Bambini L; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Bordini M; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., D'Albo R; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Nocera D; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Zernini IS; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy., Turriziani I; Cardio-Thoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Mascia L; Dipartimento di Medicina Sperimentale, Campus Ecotekne University of Salento, Lecce, Italy., Rucci P; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy., Ranieri VM; Department of Anesthesia and Intensive Care Medicine, Università degli studi di Bari 'Aldo Moro', Ospedale Policlinico, Bari, Italy.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Aug 27; Vol. 28 (1), pp. 278. Date of Electronic Publication: 2024 Aug 27.
DOI: 10.1186/s13054-024-05074-z
Abstrakt: Background: Age as an eligibility criterion for V-V ECMO is widely debated and varies among healthcare institutions. We examined how age relates to mortality in patients undergoing V-V ECMO for ARDS.
Methods: Systematic review and meta-regression of clinical studies published between 2015 and June 2024. Studies involving at least 6 ARDS patients treated with V-V ECMO, with specific data on ICU and/or hospital mortality and patient age were included. The search strategy was executed in PubMed, limited to English-language. COVID-19 and non-COVID-19 populations were analyzed separately. Meta-regressions of mortality outcomes on age were performed using gender, BMI, SAPS II, APACHE II, Charlson comorbidity index or SOFA as covariates.
Results: In non-COVID ARDS, the meta-regression of 173 studies with 56,257 participants showed a significant positive association between mean age and ICU/hospital mortality. In COVID-19 ARDS, a significant relationship between mean age and ICU mortality, but not hospital mortality, was found in 103 studies with 21,255 participants. Sensitivity analyses confirmed these findings, highlighting a linear relationship between age and mortality in both groups. For each additional year of mean age, ICU mortality increased by 1.2% in non-COVID ARDS and 1.9% in COVID ARDS.
Conclusions: The relationship between age and ICU mortality is linear and shows no inflection point. Consequently, no age cut-off can be recommended for determining patient eligibility for V-V ECMO.
(© 2024. The Author(s).)
Databáze: MEDLINE
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