Extracorporeal life support as bridge to lung transplantation: a systematic review

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• 作者：Davide Chiumello (1) (2)
  Silvia Coppola (1) (2)
  Sara Froio (1) (2)
  Andrea Colombo (2)
  Lorenzo Del Sorbo (3) (4)
  
  1. Dipartimento di Anestesia ; Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore ; Fondazione IRCCS Ca鈥?Granda ; Ospedale Maggiore Policlinico ; Via F. Sforza 35 ; 20122 ; Milano ; Italy
  2. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti ; Universit脿 degli Studi di Milano ; Milano ; Italy
  3. Interdepartmental Division of Critical Care Medicine ; University of Toronto ; Toronto ; Canada
  4. Dipartimento di Anestesiologia e Medicina degli Stati Critici ; Universit脿 di Torino ; Torino ; Italy
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：313 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at a high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The aim of this study was to assess the current evidence regarding how the ECMO bridge influences patients鈥?survival and length of hospital stay. Methods We performed a systematic review by searching PubMed, EMBASE and the bibliographies of retrieved articles. Three reviewers independently screened citation titles and abstracts and agreement was reached by consensus. We selected studies enrolling patients who received ECMO with the intention to bridge lung transplant. We included randomized controlled trials (RCTs), case鈥揷ontrol studies and case series with ten or more patients. Outcomes of interest included survival and length of hospital stay. Quantitative data summaries were made when feasible. Results We identified 82 studies, of which 14 were included in the final analysis. All 14 were retrospective studies which enrolled 441 patients in total. Because of the broad heterogeneity among the studies we did not perform a meta-analysis. The mortality rate of patients on ECMO before lung transplant and the one-year survival ranged from 10% to 50% and 50% to 90%, respectively. The intensive care and hospital length of stay ranged between a median of 15 to 47聽days and 22 to 47聽days, respectively. There was a general paucity of high-quality data and significant heterogeneity among studies in the enrolled patients and technology used, which confounded analysis. Conclusions In most of the studies, patients on ECMO while awaiting lung transplantation also received invasive mechanical ventilation. Therefore, whether ECMO as an alternative, rather than an adjunction, to invasive mechanical ventilation is a better bridging strategy to lung transplantation still remains an unresolved issue. ECMO support as a bridge for these patients could provide acceptable one-year survival. Future studies are needed to investigate ECMO as part of an algorithm of care for patients with end-stage lung disease.