Outcomes of Extracorporeal Life Support (ECLS) in Acute Severe Asthma: A Narrative Review.

IF 4.6 2区医学 Q1 RESPIRATORY SYSTEM

Lung Pub Date : 2024-04-01 Epub Date: 2024-03-21 DOI:10.1007/s00408-023-00667-x

Nneoma Ekechukwu, Sachin Batra, Deborah Orsi, Marjan Rahmanian, Maneesha Bangar, Amira Mohamed

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Abstract

Background: In this narrative review we aimed to explore outcomes of extracorporeal life support (extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R)) as rescue therapy in patients with status asthmaticus requiring mechanical ventilation.

Methods: Multiple databases were searched for studies fulfilling inclusion criteria. Articles reporting mortality and complications of ECMO and ECCO2R in mechanically ventilated patients with acute severe asthma (ASA) were included. Pooled estimates of mortality and complications were obtained by fitting Poisson's normal modeling.

Results: Six retrospective studies fulfilled inclusion criteria thus yielding a pooled mortality rate of 17% (13-20%), pooled risk of bleeding of 22% (7-37%), mechanical complications in 26% (21-31%), infection in 8% (0-21%) and pneumothorax rate 4% (2-6%).

Conclusion: Our review identified a variation between institutions in the initiation of ECMO and ECCO2R in patients with status asthmaticus and discrepancy in the severity of illness at the time of cannulation. Despite that, mortality in these studies was relatively low with some studies reporting no mortality which could be attributed to selection bias. While ECMO and ECCO2R use in severe asthma patients is associated with complication risks, further studies exploring the use of ECMO and ECCO2R with mechanical ventilation are required to identify patients with favorable risk benefit ratio.

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体外生命支持（ECLS）在急性重症哮喘中的疗效：叙述性综述。

背景：在这篇叙述性综述中，我们旨在探讨体外生命支持（体外膜肺氧合（ECMO）和体外二氧化碳清除（ECCO2R））作为需要机械通气的哮喘状态患者的抢救疗法的结果：方法：在多个数据库中搜索符合纳入标准的研究。方法：在多个数据库中搜索了符合纳入标准的研究，并纳入了报告急性重症哮喘（ASA）机械通气患者 ECMO 和 ECCO2R 死亡率和并发症的文章。通过拟合泊松正态模型得出死亡率和并发症的汇总估计值：结果：有六项回顾性研究符合纳入标准，因此得出的总死亡率为 17% (13-20%)，出血风险为 22% (7-37%)，机械并发症为 26% (21-31%)，感染为 8% (0-21%)，气胸为 4% (2-6%)：我们的研究发现，不同机构在对哮喘患者启动 ECMO 和 ECCO2R 时存在差异，插管时的病情严重程度也不尽相同。尽管如此，这些研究中的死亡率相对较低，有些研究报告没有死亡率，这可能是由于选择偏差造成的。虽然在重症哮喘患者中使用 ECMO 和 ECCO2R 与并发症风险有关，但仍需进一步研究探讨 ECMO 和 ECCO2R 与机械通气的结合使用，以确定风险效益比良好的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lung 医学-呼吸系统

CiteScore

9.10

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.