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Meta-Analysis
. 2024 Apr 30;28(1):146.
doi: 10.1186/s13054-024-04927-x.

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Alexandra-Maria Stommel  1 , Harald Herkner  2 , Calvin Lukas Kienbacher  1 , Brigitte Wildner  3 , Alexander Hermann  4 , Thomas Staudinger  4
Affiliations
Meta-Analysis

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Alexandra-Maria Stommel et al. Crit Care. .

Abstract

Purpose: A systematic review and meta-analysis to evaluate the impact of extracorporeal carbon dioxide removal (ECCO2R) on gas exchange and respiratory settings in critically ill adults with respiratory failure.

Methods: We conducted a comprehensive database search, including observational studies and randomized controlled trials (RCTs) from January 2000 to March 2022, targeting adult ICU patients undergoing ECCO2R. Primary outcomes were changes in gas exchange and ventilator settings 24 h after ECCO2R initiation, estimated as mean of differences, or proportions for adverse events (AEs); with subgroup analyses for disease indication and technology. Across RCTs, we assessed mortality, length of stay, ventilation days, and AEs as mean differences or odds ratios.

Results: A total of 49 studies encompassing 1672 patients were included. ECCO2R was associated with a significant decrease in PaCO2, plateau pressure, and tidal volume and an increase in pH across all patient groups, at an overall 19% adverse event rate. In ARDS and lung transplant patients, the PaO2/FiO2 ratio increased significantly while ventilator settings were variable. "Higher extraction" systems reduced PaCO2 and respiratory rate more efficiently. The three available RCTs did not demonstrate an effect on mortality, but a significantly longer ICU and hospital stay associated with ECCO2R.

Conclusions: ECCO2R effectively reduces PaCO2 and acidosis allowing for less invasive ventilation. "Higher extraction" systems may be more efficient to achieve this goal. However, as RCTs have not shown a mortality benefit but increase AEs, ECCO2R's effects on clinical outcome remain unclear. Future studies should target patient groups that may benefit from ECCO2R. PROSPERO Registration No: CRD 42020154110 (on January 24, 2021).

Keywords: Acute respiratory distress syndrome (ARDS); Extraction capacity; Hypercapnic acidosis; Interventional lung assist.

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Conflict of interest statement

TS received speaker fees from Xenios, Getinge, Mitsubishi Pharma and Baxter. He participates on the advisory board of Xenios. AH received speaker fees from Getinge. HH is coordinating editor of Cochrane emergency critical care. AS, BW and CK declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for new systematic reviews which included searches of databases and registers only
Fig. 2
Fig. 2
Change of (a) PaCO2, mmHg, and (b) pH within 24 h after initiating ECCO2R (diagnoses subgroups)
Fig. 3
Fig. 3
Change of (a) plateau pressure, cmH2O, (b) respiratory rate, breaths/min, and (c) tidal volume, mL within 24 h after initiating ECCO2R (diagnoses subgroups)
Fig. 4
Fig. 4
Change of (a) PaCO2, mmHg, and (b) pH within 24 h after initiating ECCO2R (lower extraction and higher extraction subgroups)
See this image and copyright information in PMC

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