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.

中文翻译：

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急性重度哮喘的体外生命支持 (ECLS) 的结果：叙述性回顾

背景

在这篇叙述性综述中，我们旨在探讨体外生命支持（体外膜氧合（ECMO）和体外二氧化碳清除（ECCO2R））作为需要机械通气的哮喘持续状态患者的抢救治疗的结果。

方法

检索了多个数据库以查找符合纳入标准的研究。其中包括报告 ECMO 和 ECCO2R 在机械通气急性重症哮喘 (ASA) 患者中的死亡率和并发症的文章。通过拟合泊松正态模型获得死亡率和并发症的汇总估计值。

结果

六项回顾性研究符合纳入标准，因此得出的汇总死亡率为 17%（13-20%），汇总出血风险为 22%（7-37%），机械并发症为 26%（21-31%），感染8% (0–21%) 和气胸发生率 4% (2–6%)。

结论

我们的审查发现，不同机构在哮喘持续状态患者启动 ECMO 和 ECCO2R 方面存在差异，并且插管时疾病严重程度也存在差异。尽管如此，这些研究中的死亡率相对较低，一些研究报告没有死亡率，这可能归因于选择偏差。虽然 ECMO 和 ECCO2R 在严重哮喘患者中的使用与并发症风险相关，但需要进一步研究探索 ECMO 和 ECCO2R 与机械通气的使用，以确定具有良好风险收益比的患者。