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Meta-Analysis
. 2024 Aug 27;28(1):278.
doi: 10.1186/s13054-024-05074-z.

Role of age as eligibility criterion for ECMO in patients with ARDS: meta-regression analysis

Tommaso Tonetti  1   2 , Rossana Di Staso  3 , Laura Bambini  3 , Martina Bordini  3 , Rosanna D'Albo  3 , Domenico Nocera  3 , Irene Sbaraini Zernini  3 , Ilaria Turriziani  4 , Luciana Mascia  5 , Paola Rucci  6 , V Marco Ranieri  7
Affiliations
Meta-Analysis

Role of age as eligibility criterion for ECMO in patients with ARDS: meta-regression analysis

Tommaso Tonetti et al. Crit Care. .

Abstract

Background: Age as an eligibility criterion for V-V ECMO is widely debated and varies among healthcare institutions. We examined how age relates to mortality in patients undergoing V-V ECMO for ARDS.

Methods: Systematic review and meta-regression of clinical studies published between 2015 and June 2024. Studies involving at least 6 ARDS patients treated with V-V ECMO, with specific data on ICU and/or hospital mortality and patient age were included. The search strategy was executed in PubMed, limited to English-language. COVID-19 and non-COVID-19 populations were analyzed separately. Meta-regressions of mortality outcomes on age were performed using gender, BMI, SAPS II, APACHE II, Charlson comorbidity index or SOFA as covariates.

Results: In non-COVID ARDS, the meta-regression of 173 studies with 56,257 participants showed a significant positive association between mean age and ICU/hospital mortality. In COVID-19 ARDS, a significant relationship between mean age and ICU mortality, but not hospital mortality, was found in 103 studies with 21,255 participants. Sensitivity analyses confirmed these findings, highlighting a linear relationship between age and mortality in both groups. For each additional year of mean age, ICU mortality increased by 1.2% in non-COVID ARDS and 1.9% in COVID ARDS.

Conclusions: The relationship between age and ICU mortality is linear and shows no inflection point. Consequently, no age cut-off can be recommended for determining patient eligibility for V-V ECMO.

Keywords: ARDS; Age; V-V ECMO.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Meta-regression of ICU mortality on mean age reported by authors or estimated using Wan’s formula when only median and IQR was reported in studies including non-COVID-19 patients (panel A) and COVID-19 patients (panel B). Each study is represented by a circle sized according to the study weight. The red line represents the linear regression estimate
Fig. 2
Fig. 2
Meta-regression of in-hospital mortality on mean age reported by authors or estimated using Wan’s formula when only median and IQR was reported in studies including non-COVID-19 patients (panel A) and COVID-19 patients (panel B). Each study is represented by a circle sized according to the study weight. The red line represents the linear regression estimate
See this image and copyright information in PMC

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