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Review
. 2024 Apr;202(2):91-96.
doi: 10.1007/s00408-023-00667-x. Epub 2024 Mar 21.

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

Nneoma Ekechukwu  1 , Sachin Batra  2 , Deborah Orsi  1 , Marjan Rahmanian  1 , Maneesha Bangar  1 , Amira Mohamed  1
Affiliations
Review

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

Nneoma Ekechukwu et al. Lung. 2024 Apr.

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.

Keywords: Acute severe asthma; Extracorporeal carbon dioxide removal (ECCO2R); Extracorporeal life support; Extracorporeal membrane oxygenation (ECMO); Status asthmaticus.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ECCO2R studies selection
Fig. 2
Fig. 2
ECMO studies selection
See this image and copyright information in PMC

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