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Meta-Analysis
. 2022 May;46(5):763-774.
doi: 10.1111/aor.14130. Epub 2021 Dec 12.

Utilization and outcomes of extracorporeal CO2 removal (ECCO2 R): Systematic review and meta-analysis of arterio-venous and veno-venous ECCO2 R approaches

Tiffany Z Yu  1 , Robert T Tatum  1 , Abhiraj Saxena  1 , Danial Ahmad  1 , Colin C Yost  1 , Elizabeth J Maynes  1 , Thomas J O'Malley  1 , Howard T Massey  1 , Justyna Swol  2 , Bryan A Whitson  3 , Vakhtang Tchantchaleishvili  1
Affiliations
Meta-Analysis

Utilization and outcomes of extracorporeal CO2 removal (ECCO2 R): Systematic review and meta-analysis of arterio-venous and veno-venous ECCO2 R approaches

Tiffany Z Yu et al. Artif Organs. 2022 May.

Abstract

Introduction: Extracorporeal carbon dioxide removal (ECCO2 R) provides respiratory support to patients suffering from hypercapnic respiratory failure by utilizing an extracorporeal shunt and gas exchange membrane to remove CO2 from either the venous (VV-ECCO2 R) or arterial (AV-ECCO2 R) system before return into the venous site. AV-ECCO2 R relies on the patient's native cardiac function to generate pressures needed to deliver blood through the extracorporeal circuit. VV-ECCO2 R utilizes a mechanical pump and can be used to treat patients with inadequate native cardiac function. We sought to evaluate the existing evidence comparing the subgroups of patients supported on VV and AV-ECCO2 R devices.

Methods: A literature search was performed to identify all relevant studies published between 2000 and 2019. Demographic information, medical indications, perioperative variables, and clinical outcomes were extracted for systematic review and meta-analysis.

Results: Twenty-five studies including 826 patients were reviewed. 60% of patients (497/826) were supported on VV-ECCO2 R. The most frequent indications were acute respiratory distress syndrome (ARDS) [69%, (95%CI: 53%-82%)] and chronic obstructive pulmonary disease (COPD) [49%, (95%CI: 37%-60%)]. ICU length of stay was significantly shorter in patients supported on VV-ECCO2 R compared to AV-ECCO2 R [15 (95%CI: 7-23) vs. 42 (95%CI: 17-67) days, p = 0.05]. In-hospital mortality was not significantly different [27% (95%CI: 18%-38%) vs. 36% (95%CI: 24%-51%), p = 0.26].

Conclusion: Both VV and AV-ECCO2 R provided clinically meaningful CO2 removal with comparable mortality.

Keywords: ARDS: acute respiratory distress syndrome; COPD: chronic obstructive pulmonary disease; ECCO2R: extracorporeal carbon dioxide removal; bridge to lung transplantation; hypercapnic; respiratory failure.

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References

REFERENCES

    1. Conrad SA, Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, et al. The extracorporeal life support organization Maastricht treaty for nomenclature in extracorporeal life support. A position paper of the extracorporeal life support organization. Am J Respir Crit Care Med. 2018;198:447-51.
    1. Gattinoni L, Vassalli F, Romitti F, Vasques F, Pasticci I, Duscio E, et al. Extracorporeal gas exchange: when to start and how to end? Crit Care. 2019;23(S1):203. https://doi.org/10.1186/s13054-019-2437-2
    1. Lo Coco V, Lorusso R, Raffa GM, Malvindi PG, Pilato M, Martucci G, et al. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock: still the achille’s heel. J Thorac Dis. 2018;10(12):6993-7004. https://doi.org/10.21037/jtd.2018.11.103
    1. Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T, et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42:889-96.
    1. Giraud R, Banfi C, Assouline B, De Charrière A, Cecconi M, Bendjelid K. The use of extracorporeal CO2 removal in acute respiratory failure. Ann Intensive Care. 2021;11(1):43. https://doi.org/10.1186/s13613-021-00824-6

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