Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome

Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Vaquer, Sergi [verfasserIn] de Haro, Candelaria [verfasserIn] Peruga, Paula [verfasserIn] Oliva, Joan Carles [verfasserIn] Artigas, Antonio [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2017

Schlagwörter:	Extracorporeal life support (ECLS) Extracorporeal CO removal (ECCO R) Acute respiratory failure (ARF) Mechanical ventilation H1N1 Extracorporeal bypass

Übergeordnetes Werk:	Enthalten in: Annals of intensive care - Heidelberg : Springer, 2011, 7(2017), 1 vom: 12. Mai
Übergeordnetes Werk:	volume:7 ; year:2017 ; number:1 ; day:12 ; month:05

Links:	Volltext

DOI / URN:	10.1186/s13613-017-0275-4

Katalog-ID:	SPR031930395

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520			\|a Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited.
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allfields	10.1186/s13613-017-0275-4 doi (DE-627)SPR031930395 (SPR)s13613-017-0275-4-e DE-627 ger DE-627 rakwb eng 610 ASE Vaquer, Sergi verfasserin aut Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited. Extracorporeal life support (ECLS) (dpeaa)DE-He213 Extracorporeal CO (dpeaa)DE-He213 removal (ECCO (dpeaa)DE-He213 R) (dpeaa)DE-He213 Acute respiratory failure (ARF) (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 H1N1 (dpeaa)DE-He213 Extracorporeal bypass (dpeaa)DE-He213 de Haro, Candelaria verfasserin aut Peruga, Paula verfasserin aut Oliva, Joan Carles verfasserin aut Artigas, Antonio verfasserin aut Enthalten in Annals of intensive care Heidelberg : Springer, 2011 7(2017), 1 vom: 12. Mai (DE-627)664260918 (DE-600)2617094-2 2110-5820 nnns volume:7 year:2017 number:1 day:12 month:05 https://dx.doi.org/10.1186/s13613-017-0275-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2017 1 12 05
spelling	10.1186/s13613-017-0275-4 doi (DE-627)SPR031930395 (SPR)s13613-017-0275-4-e DE-627 ger DE-627 rakwb eng 610 ASE Vaquer, Sergi verfasserin aut Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited. Extracorporeal life support (ECLS) (dpeaa)DE-He213 Extracorporeal CO (dpeaa)DE-He213 removal (ECCO (dpeaa)DE-He213 R) (dpeaa)DE-He213 Acute respiratory failure (ARF) (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 H1N1 (dpeaa)DE-He213 Extracorporeal bypass (dpeaa)DE-He213 de Haro, Candelaria verfasserin aut Peruga, Paula verfasserin aut Oliva, Joan Carles verfasserin aut Artigas, Antonio verfasserin aut Enthalten in Annals of intensive care Heidelberg : Springer, 2011 7(2017), 1 vom: 12. Mai (DE-627)664260918 (DE-600)2617094-2 2110-5820 nnns volume:7 year:2017 number:1 day:12 month:05 https://dx.doi.org/10.1186/s13613-017-0275-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2017 1 12 05
allfields_unstemmed	10.1186/s13613-017-0275-4 doi (DE-627)SPR031930395 (SPR)s13613-017-0275-4-e DE-627 ger DE-627 rakwb eng 610 ASE Vaquer, Sergi verfasserin aut Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited. Extracorporeal life support (ECLS) (dpeaa)DE-He213 Extracorporeal CO (dpeaa)DE-He213 removal (ECCO (dpeaa)DE-He213 R) (dpeaa)DE-He213 Acute respiratory failure (ARF) (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 H1N1 (dpeaa)DE-He213 Extracorporeal bypass (dpeaa)DE-He213 de Haro, Candelaria verfasserin aut Peruga, Paula verfasserin aut Oliva, Joan Carles verfasserin aut Artigas, Antonio verfasserin aut Enthalten in Annals of intensive care Heidelberg : Springer, 2011 7(2017), 1 vom: 12. Mai (DE-627)664260918 (DE-600)2617094-2 2110-5820 nnns volume:7 year:2017 number:1 day:12 month:05 https://dx.doi.org/10.1186/s13613-017-0275-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2017 1 12 05
allfieldsGer	10.1186/s13613-017-0275-4 doi (DE-627)SPR031930395 (SPR)s13613-017-0275-4-e DE-627 ger DE-627 rakwb eng 610 ASE Vaquer, Sergi verfasserin aut Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited. Extracorporeal life support (ECLS) (dpeaa)DE-He213 Extracorporeal CO (dpeaa)DE-He213 removal (ECCO (dpeaa)DE-He213 R) (dpeaa)DE-He213 Acute respiratory failure (ARF) (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 H1N1 (dpeaa)DE-He213 Extracorporeal bypass (dpeaa)DE-He213 de Haro, Candelaria verfasserin aut Peruga, Paula verfasserin aut Oliva, Joan Carles verfasserin aut Artigas, Antonio verfasserin aut Enthalten in Annals of intensive care Heidelberg : Springer, 2011 7(2017), 1 vom: 12. Mai (DE-627)664260918 (DE-600)2617094-2 2110-5820 nnns volume:7 year:2017 number:1 day:12 month:05 https://dx.doi.org/10.1186/s13613-017-0275-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2017 1 12 05
allfieldsSound	10.1186/s13613-017-0275-4 doi (DE-627)SPR031930395 (SPR)s13613-017-0275-4-e DE-627 ger DE-627 rakwb eng 610 ASE Vaquer, Sergi verfasserin aut Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome 2017 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited. Extracorporeal life support (ECLS) (dpeaa)DE-He213 Extracorporeal CO (dpeaa)DE-He213 removal (ECCO (dpeaa)DE-He213 R) (dpeaa)DE-He213 Acute respiratory failure (ARF) (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 H1N1 (dpeaa)DE-He213 Extracorporeal bypass (dpeaa)DE-He213 de Haro, Candelaria verfasserin aut Peruga, Paula verfasserin aut Oliva, Joan Carles verfasserin aut Artigas, Antonio verfasserin aut Enthalten in Annals of intensive care Heidelberg : Springer, 2011 7(2017), 1 vom: 12. Mai (DE-627)664260918 (DE-600)2617094-2 2110-5820 nnns volume:7 year:2017 number:1 day:12 month:05 https://dx.doi.org/10.1186/s13613-017-0275-4 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2017 1 12 05
language	English
source	Enthalten in Annals of intensive care 7(2017), 1 vom: 12. Mai volume:7 year:2017 number:1 day:12 month:05
sourceStr	Enthalten in Annals of intensive care 7(2017), 1 vom: 12. Mai volume:7 year:2017 number:1 day:12 month:05
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Extracorporeal life support (ECLS) Extracorporeal CO removal (ECCO R) Acute respiratory failure (ARF) Mechanical ventilation H1N1 Extracorporeal bypass
dewey-raw	610
isfreeaccess_bool	true
container_title	Annals of intensive care
authorswithroles_txt_mv	Vaquer, Sergi @@aut@@ de Haro, Candelaria @@aut@@ Peruga, Paula @@aut@@ Oliva, Joan Carles @@aut@@ Artigas, Antonio @@aut@@
publishDateDaySort_date	2017-05-12T00:00:00Z
hierarchy_top_id	664260918
dewey-sort	3610
id	SPR031930395
language_de	englisch
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author	Vaquer, Sergi
spellingShingle	Vaquer, Sergi ddc 610 misc Extracorporeal life support (ECLS) misc Extracorporeal CO misc removal (ECCO misc R) misc Acute respiratory failure (ARF) misc Mechanical ventilation misc H1N1 misc Extracorporeal bypass Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome
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topic_title	610 ASE Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome Extracorporeal life support (ECLS) (dpeaa)DE-He213 Extracorporeal CO (dpeaa)DE-He213 removal (ECCO (dpeaa)DE-He213 R) (dpeaa)DE-He213 Acute respiratory failure (ARF) (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 H1N1 (dpeaa)DE-He213 Extracorporeal bypass (dpeaa)DE-He213
topic	ddc 610 misc Extracorporeal life support (ECLS) misc Extracorporeal CO misc removal (ECCO misc R) misc Acute respiratory failure (ARF) misc Mechanical ventilation misc H1N1 misc Extracorporeal bypass
topic_unstemmed	ddc 610 misc Extracorporeal life support (ECLS) misc Extracorporeal CO misc removal (ECCO misc R) misc Acute respiratory failure (ARF) misc Mechanical ventilation misc H1N1 misc Extracorporeal bypass
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title	Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome
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title_full	Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome
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title_sort	systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome
title_auth	Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome
abstract	Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited.
abstractGer	Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited.
abstract_unstemmed	Abstract Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited.
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title_short	Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome
url	https://dx.doi.org/10.1186/s13613-017-0275-4
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author2	de Haro, Candelaria Peruga, Paula Oliva, Joan Carles Artigas, Antonio
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We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8–44.1; I2 = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1–45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R2 = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = −0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8–56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8–39.6). Mortality due to complications was 6.9% (CI 95% = 4.1–11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7–23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1–21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. 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Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome

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