Introduction
Background
Patients of the Brazilian tertiary medical center
Systematic review of the literature
Registration
Search strategy
Study evaluation and data extraction
Quality assessment
Statistical analysis
Results
Brazilian medical center
General characteristics | All patients (n = 7) |
---|---|
Age (yo) | 28 [14,48] |
Male [n(%)] | 3 [43] |
SAPS 3 | 84 [57,118] |
SOFA | 13 [7,18] |
Lung injury score | 4 [3,4] |
Acute respiratory failure etiology
| |
Pneumonia [n(%)] | 4 [57] |
Syncytial respiratory virus [n (%)] | 1 [14] |
Influenza A virus (H3N2) [n (%)] | 1 [14] |
Varicella zoster virus [n (%)] | 1 [14] |
Nosocomial pneumonia [n (%)] | 2 [28] |
Alveolar hemorrhage [n (%)] | 1 [14] |
Pre-ECMO initiation hospital data
| |
Hospital LOS (days) | 8 [3,30] |
Days on mechanical ventilation | 8 [1,19] |
Pre-ECMO rescue maneuvers
| |
Alveolar recruitment [n (%)] | 7 (100) |
Nitric oxide [n (%)] | 1 [14] |
Neuromuscular blockers [n (%)] | 4 [57] |
Corticosteroids [n (%)] | 3 [43] |
Tracheal gas insufflation [n (%)] | 1 [14] |
Clinical outcomes
| |
ECMO weaning [n (%)] | 5 (71) |
Time on ECMO support (days) | 5 [2, 10] |
Hospital discharge | 4 (57) |
90-day survival [n (%)] | 4 (57) |
Ventilatory settings | Pre-ECMO initiation | After ECMO initiation |
---|---|---|
Ventilatory mode (n) | 6 PCV/1 VCV | 7 PCV |
Tidal volume (mL/kg) | 310 [180, 500] | 100 [12, 220] |
Plateau pressure (cmH2O) | 35 [31, 46] | 20 [20, 25] |
PEEP (cmH2O) | 18 [13, 25] | 10 [10, 20] |
Resp. rate (insp./min.) | 26 [25, 35] | 10 [10, 10] |
FiO2
| 1.0 [1.0, 1.0] | 0.3 [0.21, 1.0] |
Systematic review
Study inclusion
Outcomes
Characteristic | ≥12 years old | <12 years old | ||
---|---|---|---|---|
Patients analyzed Total N = 682 | Mean (CI 95%) | Patients analyzed Total N = 365 | Mean (CI 95%) | |
Age (yo) | 627 | 38 (35–41) | 114 | 3.1 (1.4–4.8) |
Male gender (%) | 482 | 61 (45–77) | 365 | 17 (13–21) |
Weight (kg) | 119 | 74 (67–82) | 37 | 23.6 (17.6–29.6) |
Pre-ECMO status
| ||||
Time on MV (days) | 246 | 4.6 (3.7–5.5) | – | – |
pH | 242 | 7.24 (7.19–7.28) | 32 | 7.26 (7.23–7.29) |
P/F ratio (mmHg) | 373 | 59 (40–78) | – | – |
PCO2 (mmHg) | 306 | 71 (63–78) | – | – |
APACHE II | 53 | 22 (21–23) | – | – |
SAPS 2 | 128 | 46 (40–52) | – | – |
SAPS 3 | 10 | 86 (80–92) | – | – |
Diagnosis
| ||||
ARDS (%) | 682 | 30 (26–34) | 365 | 14 (11–18) |
Bacterial pneumonia (%) | 682 | 27 (23–31) | 365 | 6 (4–9) |
Viral pneumonia (%) | 682 | 22 (19–25) | 365 | 5 (3–7) |
Respiratory and right ventricle failure (%) | 682 | 19 (12–26) | 365 | 17 (13–21) |
Trauma (%) | 682 | 4 (3–6) | 365 | 0 |
Aspiration syndromes (%) | 682 | 3 (1–4) | 365 | 1.0 (0.1–2.5) |
Meconium aspiration syndrome (%) | 682 | 0 | 365 | 19 (15–23) |
Congenital diaphragmatic hernia (%) | 682 | 0 | 365 | 8 (5–11) |
Persistent newborn pulmonary hypertension (%) | 682 | 0 | 365 | 8 (5–10) |
ECMO support and outcome data
| ||||
ECMO support duration (days) | 458 | 9.8 (8.6–10.9) | 7.5 | – |
Venovenous configuration (%) | 682 | 62 (59–66) | 365 | 42 (35–50) |
Venoarterial configuration (%) | 682 | 16 (13–19) | 365 | 58 (50–65) |
ICU LOS (days) | 64 | 22 (15–30) | – | – |
Hospital LOS (days) | 119 | 32 (25–38) | – | – |
Patients analyzed (Total N = 1481) | Mean (CI 95%) | |
---|---|---|
Rescue mission
| ||
Distance of transportation (km) | 444 | 486 (68–904) |
Rescue time lasting (hours) | 318 | 17 (9–27) |
Ambulance (%) | 1481 | 53 (50–56) |
Fixed wing (%) | 1481 | 27 (25–31) |
Helicopter (%) | 1481 | 22 (19–24) |
International transportation (%) | 1481 | 7 (5–8) |
Adverse events on the rescue mission
| ||
Death during transport (%) | 1481 | 2 deaths (0.1%) |
Tidal volume fall (%) | 1481 | 4 (3–5) |
System rupture (%) | 1481 | 1.0 (0.4–1.6) |
Any bleeding (%) | 1481 | 0.9 (0.3–1.4) |
Power failure (%) | 1481 | 0.5 (0.1–0.9) |
Hypotension (%) | 1481 | 0.4 (0.1–0.8) |
Cannulae dislodgement (%) | 1481 | 0.2 (0.1–0.7) |
Others (%) | 1481 | 0.9 (0.3–1.4) |
Absence of complications (%) | 1481 | 92 (91–94) |