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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2022, Vol. 15 ›› Issue (01) : 51 -59. doi: 10.3877/cma.j.issn.1674-6880.2022.01.010

荟萃分析

体外膜肺氧合治疗脓毒症患者生存预后的Meta分析
康绍涛1, 布祖克拉·阿布都艾尼2, 李英杰1, 拜合提尼沙·吐尔地1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院呼吸重症监护病房
    2. 830054　乌鲁木齐，新疆医科大学第一附属医院重症医学科
  • 收稿日期:2021-12-25 出版日期:2022-02-28
  • 通信作者: 拜合提尼沙·吐尔地
  • 基金资助:
    新疆维吾尔自治区自然科学基金项目(2016D01C255)

Survival prognosis of extracorporeal membrane oxygenation on patients with sepsis: a meta-analysis

Shaotao Kang1, Abuduaini Buzukela·2, Yingjie Li1, Tuerdi Baihetinisha·1,†()   

  1. 1. Department of Respiratory Intensive Care Unit, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, China
    2. Department of Intensive Care Unit, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, China
  • Received:2021-12-25 Published:2022-02-28
  • Corresponding author: Tuerdi Baihetinisha·
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引用本文：

康绍涛, 布祖克拉·阿布都艾尼, 李英杰, 拜合提尼沙·吐尔地. 体外膜肺氧合治疗脓毒症患者生存预后的Meta分析[J]. 中华危重症医学杂志(电子版), 2022, 15(01): 51-59.

Shaotao Kang, Abuduaini Buzukela·, Yingjie Li, Tuerdi Baihetinisha·. Survival prognosis of extracorporeal membrane oxygenation on patients with sepsis: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(01): 51-59.

目的

系统评价体外膜肺氧合（ECMO）对脓毒症患者生存率的影响。

方法

计算机检索知网、万方、维普、中国生物医学文献服务系统、PubMed、Web of Science、Cochrane Library、Embase等数据库2011年1月至2020年7月期间公开发表的关于ECMO治疗脓毒症患者的相关研究。由2名研究人员独立进行文献筛选、数据提取及质量评估，并采用Stata 15.0软件进行单臂研究的Meta分析。

结果

共纳入13篇研究，合计660例患者。Meta分析结果示，ECMO治疗[相对危险度（RR） = 0.32，95%置信区间（CI）（0.22，0.42），Z = 9.841，P < 0.001]、静脉-动脉ECMO（VA-ECMO）治疗[RR = 0.29，95%CI（0.17，0.42），Z = 7.100，P < 0.001]及静脉-静脉ECMO（VV-ECMO）治疗[RR = 0.53，95%CI（0.40，0.66），Z = 14.950，P < 0.001]均可明显提高脓毒症患者的出院生存率。且对于脓毒性休克患者的出院生存率[RR = 0.33，95%CI（0.19，0.46），Z = 4.686，P < 0.001]、肺部感染导致脓毒症患者的出院生存率[RR = 0.22，95%CI（0.13，0.32），Z = 7.140，P < 0.001]、年龄> 60岁脓毒症患者的出院生存率[RR = 0.06，95%CI（0.00，0.15），Z = 2.108，P = 0.011]及脓毒症患者的长期生存率[RR = 0.82，95%CI（0.70，0.94），Z = 13.410，P < 0.001]，ECMO治疗后均显著提高。

结论

ECMO治疗能改善脓毒症患者的生存预后。

关键词: 体外膜肺氧合, 脓毒症, 脓毒性休克, 生存率, Meta分析
Objective

To systematically evaluate the effect of extracorporeal membrane oxygenation (ECMO) on the survival rate of patients with sepsis.

Methods

The articles about ECMO for sepsis patients published from January 2011 to July 2020 were searched in CNKI, Wanfang, VIP, China Biomedical Literature Service System, PubMed, Web of Science, Cochrane Library, and Embase databases. Two researchers independently screened articles, extracted data, and evaluated the quality of articles. Then the meta-analysis was performed using the Stata 15.0 software.

Results

A total of 660 patients from 13 articles were included in this study. Meta-analysis showed that the discharge survival rates of sepsis patients treated by ECMO [risk ratio (RR) = 0.32, 95% confidence interval (CI) (0.22, 0.42), Z = 9.841, P < 0.001], veno-arterial ECMO (VA-ECMO) [RR = 0.29, 95%CI (0.17, 0.42), Z = 7.100, P < 0.001], and veno-venous ECMO (VV-ECMO) [RR = 0.53, 95%CI (0.40, 0.66), Z = 14.950, P < 0.001] all improved obviously. The discharge survival rates in patients with septic shock [RR = 0.33, 95%CI (0.19, 0.46), Z = 4.686, P < 0.001], patients with sepsis caused by pulmonary infection [RR = 0.22, 95%CI (0.13, 0.32), Z = 7.140, P < 0.001], and patients with sepsis > 60 years of age [RR = 0.06, 95%CI (0.00, 0.15), Z = 2.108, P = 0.011], as well as the long-term survival rate of patients with sepsis [RR = 0.82, 95%CI (0.70, 0.94), Z = 13.410, P < 0.001] all increased remarkably after ECMO treatment.

Conclusion

ECMO treatment can improve the prognosis of patients with sepsis.

Key words: Extracorporeal membrane oxygenation, Sepsis, Shock, septic, Survival rate, Meta-analysis
表1 纳入文献基本资料及质量评价
纳入研究 例数（休克例数） 疾病类型 出院生存例数（休克生存例数） 年龄（岁，中位数） 生存比例（生存人数/总人数） 长期生存例数（随访月数） 质量评价（分）
存活组 死亡组 VA-ECMO VV-ECMO 肺源性 年龄>60岁
Huang等[9] 52 脓毒性休克 8 43.8 59.3 - - 6/25 0/20 - 14
Cheng等[10] 108 脓毒症 31 52.0 21/86 10/22 - - - 14
Park等[11] 32 脓毒性休克 7 53 56 7/32 - 3/11 - - 14
Choi等[12] 28 脓毒性休克 10 39 51.5 6/21 3/4 3/13 - 9（13.9） 14
Cheng等[13] 151（91） 脓毒症及脓毒性休克 45（25） 43 55 25/101 20/50 18/76 4/30 - 14
Ro等[14] 71 脓毒性休克 5 58.0 57.5 5/71 - 3/49 - - 14
Takauji等[15] 40 脓毒症 19 66 - 19/40   - - 14
Takauji等[16] 30 脓毒症 6 55 55 6/30 - 1/8 - - 14
Kim等[17] 37 脓毒性休克 15 44.0 52.5 7/26 7/8 6/17 - - 14
Banjas等[18] 19 脓毒性休克 8 62 - - - - - 14
Han等[19] 23 脓毒性休克 5 45 54 5/23 - - - - 14
Myers等[20] 32 脓毒性休克 13 34 46 5/11 8/21 9/23 - - 14
Falk等[21] 37 脓毒性休克 29 54.7 23/27 6/10 - - 22（46.1） 14
图1 ECMO治疗对脓毒症患者出院生存率影响的森林图 注：ECMO.体外膜肺氧合；RR.相对危险度；CI.置信区间
图2 VA-ECMO治疗对脓毒症患者出院生存率影响的森林图 注：VA-ECMO.静脉-动脉体外膜肺氧合；RR.相对危险度；CI.置信区间
图3 VV-ECMO治疗对脓毒症患者出院生存率影响的森林图 注：VV-ECMO.静脉-静脉体外膜肺氧合；RR.相对危险度；CI.置信区间
图4 ECMO治疗对脓毒性休克出院生存率影响的森林图 注：ECMO.体外膜肺氧合；RR.相对危险度；CI.置信区间
图5 ECMO治疗对肺部感染导致脓毒症患者出院生存率影响的森林图 注：ECMO.体外膜肺氧合；RR.相对危险度；CI.置信区间
图6 ECMO治疗对年龄> 60岁脓毒症患者出院生存率影响的森林图 注：ECMO.体外膜肺氧合；RR.相对危险度；CI.置信区间
图7 ECMO治疗对脓毒症患者长期生存率影响的森林图 注：ECMO.体外膜肺氧合；RR.相对危险度；CI.置信区间
图8 ECMO治疗对脓毒症患者出院生存率的敏感性分析 注：ECMO.体外膜肺氧合；CI.置信区间
1
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315 (8): 801-810.
2
Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315 (8): 775-787.
3
Reinhart K, Daniels R, Kissoon N, et al. Recognizing sepsis as a global health priority-a WHO resolution[J]. N Engl J Med, 2017, 377 (5): 414-417.
4
Friesecke S, Stecher SS, Gross S, et al. Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study[J]. J Artif Organs, 2017, 20 (3): 252-259.
5
Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011[J]. ASAIO J, 2015, 61 (1): 31-36.
6
Smith S, Butt W, Best D, et al. Long-term survival after extracorporeal life support in children with neutropenic sepsis[J]. Intensive Care Med, 2016, 42 (5): 942-943.
7
Oberender F, Ganeshalingham A, Fortenberry JD, et al. Venoarterial extracorporeal membrane oxygenation versus conventional therapy in severe pediatric septic shock[J]. Pediatr Crit Care Med, 2018, 19 (10): 965-972.
8
Pagani FD. Extracorporeal membrane oxygenation for septic shock: heroic futility?[J]. J Thorac Cardiovasc Surg, 2018, 156 (3): 1110-1111.
9
Huang CT, Tsai YJ, Tsai PR, et al. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock[J]. J Thorac Cardiovasc Surg, 2013, 146 (5): 1041-1046.
10
Cheng A, Sun HY, Lee CW, et al. Survival of septic adults compared with nonseptic adults receiving extracorporeal membrane oxygenation for cardiopulmonary failure: a propensity-matched analysis[J]. J Crit Care, 2013, 28 (4): 532.e1-10.
11
Park TK, Yang JH, Jeon K, et al. Extracorporeal membrane oxygenation for refractory septic shock in adults[J]. Eur J Cardiothorac Surg, 2015, 47 (2): e68-e74.
12
Choi MJ, Ha SO, Kim HS, et al. The simplified acute physiology score Ⅱ as a predictor of mortality in patients who underwent extracorporeal membrane oxygenation for septic shock[J]. Ann Thorac Surg, 2017, 103 (4): 1246-1253.
13
Cheng A, Sun HY, Tsai MS, et al. Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections[J]. J Thorac Cardiovasc Surg, 2016, 152 (6): 1526-1536.e1.
14
Ro SK, Kim WK, Lim JY, et al. Extracorporeal life support for adults with refractory septic shock[J]. J Thorac Cardiovasc Surg, 2018, 156 (3): 1104-1109.e1.
15
Takauji S, Hayakawa M, Ono K, et al. Respiratory extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a propensity score analysis in a multicenter retrospective observational study[J]. Acute Med Surg, 2017, 4 (4): 408-417.
16
Takauji S, Hayakawa M, Ono K, et al. Veno-arterial extracorporeal membrane oxygenation for severe sepsis and septic shock in adults: a retrospective study[J]. JAAM, 2017, 28 (12): 904-909.
17
Kim HS, Cheon DY, Ha SO, et al. Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation[J]. J Thorac Dis, 2018, 10 (3): 1418-1430.
18
Banjas N, Hopf HB, Hanisch E, et al. ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period[J]. J Intensive Care, 2018 (6): 84.
19
Han L, Zhang Y, Zhang Y, et al. Risk factors for refractory septic shock treated with VA ECMO[J]. Ann Transl Med, 2019, 7 (18): 476.
20
Myers LC, Lee C, Thompson BT, et al. Outcomes of adult patients with septic shock undergoing extracorporeal membrane oxygenation therapy[J]. Ann Thorac Surg, 2020, 110 (3): 871-877.
21
Falk L, Hultman J, Broman LM. Extracorporeal membrane oxygenation for septic shock[J]. Crit Care Med, 2019, 47 (8): 1097-1105.
22
Schmidt M, Bréchot N, Hariri S, et al. Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation[J]. Clin Infect Dis, 2012, 55 (12): 1633-1641.
23
Abrams D, Brodie D. Extracorporeal membrane oxygenation for adult respiratory failure: 2017 update[J]. Chest, 2017, 152 (3): 639-649.
24
Cheng R, Hachamovitch R, Kittleson M, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients[J]. Ann Thorac Surg, 2014, 97 (2): 610-616.
25
Mosier JM, Kelsey M, Raz Y, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions[J]. Crit Care, 2015 (19): 431.
26
Koster A, Ljajikj E, Faraoni D. Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation[J]. Ann Cardiothorac Surg, 2019, 8 (1): 129-136.
27
Andrews J, Winkler AM. Challenges with navigating the precarious hemostatic balance during extracorporeal life support: implications for coagulation and transfusion management[J]. Transfus Med Rev, 2016, 30 (4): 223-229.
28
Hu D, Liu K, Li B, et al. Large intracardiac thrombus in a COVID-19 patient treated with prolonged extracorporeal membrane oxygenation implantation[J]. Eur Heart J, 2020, 41 (32): 3104-3105.
29
Aubron C, Cheng AC, Pilcher D, et al. Infections acquired by adults who receive extracorporeal membrane oxygenation: risk factors and outcome[J]. Infect Control Hosp Epidemiol, 2013, 34 (1): 24-30.
30
Kaushal M, Schwartz J, Gupta N, et al. Patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications associated with survival to discharge or 30-day survival in adult patients receiving venoarterial (VA) and venovenous (VV) ECMO in a quaternary care urban center[J]. J Cardiothorac Vasc Anesth, 2019, 33 (4): 910-917.
31
Kon ZN, Bittle GJ, Pasrija C, et al. Venovenous versus venoarterial extracorporeal membrane oxygenation for adult patients with acute respiratory distress syndrome requiring precannulation hemodynamic support: a review of the ELSO registry[J]. Ann Thorac Surg, 2017, 104 (2): 645-649.
32
Bizzarro MJ, Conrad SA, Kaufman DA, et al. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults[J]. Pediatr Crit Care Med, 2011, 12 (3): 277-281.
33
Skinner SC, Iocono JA, Ballard HO, et al. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry[J]. J Pediatr Surg, 2012, 47 (1): 63-67.
34
宋立成，韩志海.脓毒症相关凝血功能障碍机制及治疗的研究进展[J/CD].中华危重症医学杂志（电子版），2017，10（2）：125-129.
35
Nguyen BA, Fiorentino F, Reeves BC, et al. Mini bypass and proinflammatory leukocyte activation: a randomized controlled trial[J]. Ann Thorac Surg, 2016, 101 (4): 1454-1463.
36
Giuliano KK, Baker D. Sepsis in the context of nonventilator hospital-acquired pneumonia[J]. Am J Crit Care, 2020, 29 (1): 9-14.
37
Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial[J]. Lancet, 2009, 374 (9698): 1351-1363.
38
Munshi L, Walkey A, Goligher E, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis[J]. Lancet Respir Med, 2019, 7 (2): 163-172.
39
Falcoz PE, Monnier A, Puyraveau M, et al. Extracorporeal membrane oxygenation for critically ill patients with COVID-19-related acute respiratory distress syndrome: worth the effort?[J]. Am J Respir Crit Care Med, 2020, 202 (3): 460-463.
40
Le Breton C, Besset S, Freita-Ramos S, et al. Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome[J]. J Crit Care, 2020 (60): 10-12.
41
Roch A, Hraiech S, Masson E, et al. Outcome of acute respiratory distress syndrome patients treated with extracorporeal membrane oxygenation and brought to a referral center[J]. Intensive Care Med, 2014, 40 (1): 74-83.
42
Banjas N, Hopf HB, Hanisch E, et al. ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: mortality and ECMO-learning curve over a 6-year period[J]. J Intensive, 2019 (7): 8.
43
Liang W, Chen C, Li L, et al. Effect of immune function on prognosis of patients with sepsis[J]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2018, 30 (12): 1128-1131.
44
冯迟，刘晓巍，王玥.改善脓毒症患者出院预后的临床研究进展[J].中国医药，2020，15（8）：1324-1328.
45
Seidel G, Gaser C, Gotz T, et al. Accelerated brain ageing in sepsis survivors with cognitive long-term impairment[J]. Eur J Neurosci, 2020, 52 (10): 4395-4402.
46
Schmidt M, Zogheib E, Rozé H, et al. The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome[J]. Intensive Care Med, 2013, 39 (10): 1704-1713.
47
Bréchot N, Luyt CE, Schmidt M, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock[J]. Crit Care Med, 2013, 41 (7): 1616-1626.
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