Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis
- Burns & Trauma Vol. 11, Issue 1, (2023)
- 作者机构：
1. Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University)
2. Department of Intensive Care Medicine, PLA 80th Group Army Hospital
- 作者简介：
- 基金信息：
DOI：10.1093/burnst/tkac056
CLC：Published：2023，
Published Online：1 March 2023，
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Xue Heng, Peng Cai, Zhiqiang Yuan, Yizhi Peng, Gaoxing Luo, Haisheng Li, Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis, Burns & Trauma, Volume 11, 2023, tkac056, https://doi.org/10.1093/burnst/tkac056
摘要
Abstract
BackgroundRespiratory and circulatory dysfunction are common complications and the leading causes of death among burn patients
especially in severe burns and inhalation injury. Recently
extracorporeal membrane oxygenation (ECMO) has been increasingly applied in burn patients. However
current clinical evidence is weak and conflicting. This study aimed to comprehensively evaluate the efficacy and safety of ECMO in burn patients.MethodsA comprehensive search of PubMed
Web of Science and Embase from inception to 18 March 2022 was performed to identify clinical studies on ECMO in burn patients. The main outcome was in-hospital mortality. Secondary outcomes included successful weaning from ECMO and complications associated with ECMO. Meta-analysis
meta-regression and subgroup analyses were conducted to pool the clinical efficacy and identify influencing factors.ResultsFifteen retrospective studies with 318 patients were finally included
without any control groups. The commonest indication for ECMO was severe acute respiratory distress syndrome (42.1%). Veno–venous ECMO was the commonest mode (75.29%). Pooled in-hospital mortality was 49% [95% confidence interval (CI) 41–58%] in the total population
55% in adults and 35% in pediatrics. Meta-regression and subgroup analysis found that mortality significantly increased with inhalation injury but decreased with ECMO duration. For studies with percentage inhalation injury ≥50%
pooled mortality (55%
95% CI 40–70%) was higher than in studies with percentage inhalation injury <50% (32%
95% CI 18–46%). For studies with ECMO duration ≥10 days
pooled mortality (31%
95% CI 20–43%) was lower than in studies with ECMO duration <10 days (61%
95% CI 46–76%). In minor and major burns
pooled mortality was lower than in severe burns. Pooled percentage of successful weaning from ECMO was 65% (95% CI 46–84%) and inversely correlated with burn area. The overall rate of ECMO-related complications was 67.46%
and infection (30.77%) and bleedings (23.08%) were the two most common complications. About 49.26% of patients required continuous renal replacement therapy.ConclusionsECMO seems to be an appropriate rescue therapy for burn patients despite the relatively high mortality and complication rate. Inhalation injury
burn area and ECMO duration are the main factors influencing clinical outcomes.
关键词
Keywords
Extracorporeal membrane oxygenationBurnsAcute respiratory distress syndromeInhalation injury
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