Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO.docVIP

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Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO.doc

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Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO

Zangrilloetal.CriticalCare2013,17:R30 /content/17/1/R30 RESEARCH OpenAccess Extracorporealmembraneoxygenation(ECMO) inpatientswithH1N1influenzainfection: asystematicreviewandmeta-analysisincluding 8studiesand266patientsreceivingECMO AlbertoZangrillo1,GiuseppeBiondi-Zoccai2,GiovanniLandoni1,3*,GiacomoFrati2,4,NicolòPatroniti5, AntonioPesenti5andFedericoPappalardo1 Abstract Introduction:H1N1influenzacancausesevereacutelunginjury(ALI).Extracorporealmembraneoxygenation (ECMO)cansupportgasexchangeinpatientsfailingconventionalmechanicalventilation,butitsroleisstill controversial.Weconductedasystematicreviewandmeta-analysisonECMOforH1N1-associatedALI. Methods:CENTRAL,GoogleScholar,MEDLINE/PubMedandScopus(updated2January2012)weresystematically searched.Studiesreportingon10ormorepatientswithH1N1infectiontreatedwithECMOwereincluded. Baseline,procedural,outcomeandvaliditydataweresystematicallyappraisedandpooled,whenappropriate,with random-effectmethods. Results:From1,196initialcitations,8studieswereselected,including1,357patientswithconfirmed/suspected H1N1infectionrequiringintensivecareunitadmission,266(20%)ofwhomweretreatedwithECMO.Patientshad amedianSequentialOrganFailureAssessment(SOFA)scoreof9,andhadreceivedmechanicalventilationbefore ECMOimplementationforamedianoftwodays.ECMOwasimplantedbeforeinter-hospitalpatienttransferin72% ofcasesandinmostpatients(94%)theveno-venousconfigurationwasused.ECMOwasmaintainedforamedian of10days.Outcomeswerehighlyvariableamongtheincludedstudies,within-hospitalorshort-termmortality rangingbetween8%and65%,mainlydependingonbaselinepatientfeatures.Random-effectpooledestimates suggestedanoverallin-hospitalmortalityof28%(95%confidenceinterval18%to37%;I2=64%). Conclusions:ECMOisfeasibleandeffectiveinpatientswithALIduetoH1N1infection.Despitethis,prolonged support(morethanoneweek)isrequiredinmostcases,andsubjectswithseverecomorbiditiesormultiorgan failureremainathighriskofin-hospitaldeath. Introduction employed in several cases of complicated H1N1