ECMO for severe ARDS: systematic review and individual patient data meta-analysis
| Autor: | David Hajage, Alain Combes, Darryl Abrams, Diana Elbourne, Giles J. Peek, Agnès Dechartres, Matthieu Schmidt, Pollyanna Hardy |
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| Rok vydání: | 2020 |
| Předmět: |
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ARDS medicine.medical_specialty Randomization Original Individual patient data meta-analysis medicine.medical_treatment Critical Care and Intensive Care Medicine 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Internal medicine Anesthesiology medicine Extracorporeal membrane oxygenation Humans Randomized Controlled Trials as Topic Respiratory Distress Syndrome Cross-Over Studies Acute respiratory distress syndrome business.industry Adult patients 030208 emergency & critical care medicine Patient data medicine.disease Respiration Artificial Confidence interval 3. Good health surgical procedures operative 030228 respiratory system Meta-analysis Relative risk business |
| Zdroj: | Intensive Care Medicine |
| ISSN: | 1432-1238 0342-4642 |
| Popis: | Purpose To assess the effect of venovenous extracorporeal membrane oxygenation (ECMO) compared to conventional management in patients with severe acute respiratory distress syndrome (ARDS). Methods We conducted a systematic review and individual patient data meta-analysis of randomised controlled trials (RCTs) performed after Jan 1, 2000 comparing ECMO to conventional management in patients with severe ARDS. The primary outcome was 90-day mortality. Primary analysis was by intent-to-treat. Results We identified two RCTs (CESAR and EOLIA) and combined data from 429 patients. On day 90, 77 of the 214 (36%) ECMO-group and 103 of the 215 (48%) control group patients had died (relative risk (RR), 0.75, 95% confidence interval (CI) 0.6–0.94; P = 0.013; I2 = 0%). In the per-protocol and as-treated analyses the RRs were 0.75 (95% CI 0.6–0.94) and 0.86 (95% CI 0.68–1.09), respectively. Rescue ECMO was used for 36 (17%) of the 215 control patients (35 in EOLIA and 1 in CESAR). The RR of 90-day treatment failure, defined as death for the ECMO-group and death or crossover to ECMO for the control group was 0.65 (95% CI 0.52–0.8; I2 = 0%). Patients randomised to ECMO had more days alive out of the ICU and without respiratory, cardiovascular, renal and neurological failure. The only significant treatment-covariate interaction in subgroups was lower mortality with ECMO in patients with two or less organs failing at randomization. Conclusions In this meta-analysis of individual patient data in severe ARDS, 90-day mortality was significantly lowered by ECMO compared with conventional management. Electronic supplementary material The online version of this article (10.1007/s00134-020-06248-3) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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