背景:已知肺动脉内膜切除术(PEA)是慢性血栓栓塞性肺动脉高压(CTEPH)的治愈性干预措施。其并发症包括支气管内出血,持续性肺动脉高压,右心室衰竭,和再灌注肺损伤。体外膜氧合(ECMO)是PEA的围手术期抢救方法。尽管在几项研究中已经报道了风险因素和结果,总体趋势仍然未知。我们进行了系统评价和研究水平的荟萃分析,以了解PEA围手术期使用ECMO的结果。
方法:我们于2022年11月18日与PubMed和EMBASE进行了文献检索。我们纳入的研究包括接受PEA围手术期ECMO的患者。我们收集了包括基线人口统计在内的数据,血液动力学测量,以及ECMO的死亡率和断奶等结局,并进行了研究水平的荟萃分析。
结果:我们的综述中纳入了11项研究,共2632例患者。ECMO插入率为8.7%(225/2,625,95%CI5.9-12.5),VV-ECMO作为初始干预进行了1.1%(41/2,625,95%CI0.4-1.7)(图3),和VA-ECMO作为初始干预的7.1%(184/2,625,95%CI4.7-9.9).术前血流动力学测量显示肺血管阻力较高,平均肺动脉压,ECMO组心输出量较低。非ECMO组的死亡率为2.8%(32/1238,95%CI:1.7-4.5),ECMO组为43.5%(115/225,95%CI:30.8-56.2)。ECMO撤机成功的患者比例为72.6%(111/188,95%CI:53.4-91.7)。关于ECMO的并发症,出血和多器官功能衰竭的发生率分别为12.2%(16/79,95%CI:13.0-34.8)和16.5%(15/99,95%CI:9.1-28.1),分别。
结论:我们的系统评价显示PEA围手术期ECMO患者的基线心肺风险较高,插入率为8.7%。预计将有进一步的研究比较ECMO在接受PEA的高危患者中的使用。
Introduction: Pulmonary endarterectomy (PEA) is known to be a curative intervention for chronic thromboembolic pulmonary hypertension (CTEPH). Its complications include endobronchial bleeding, persistent pulmonary arterial hypertension, right ventricular failure, and reperfusion lung injury. Extracorporeal membranous oxygenation (ECMO) is a perioperative salvage method for PEA. Although risk factors and outcomes have been reported in several studies, overall trends remain unknown. We performed a systematic
review and study-level meta-analysis to understand the outcomes of ECMO utilization in the perioperative period of PEA. Methods: We performed a literature search with PubMed and EMBASE on 11/18/2022. We included studies including patients who underwent perioperative ECMO in PEA. We collected data including baseline demographics, hemodynamic measurements, and outcomes such as mortality and weaning of ECMO and performed a study-level meta-analysis. Results: Eleven studies with 2632 patients were included in our
review. ECMO insertion rate was 8.7% (225/2,625, 95% CI 5.9-12.5) in total, VV-ECMO was performed as the initial intervention in 1.1% (41/2,625, 95% CI 0.4-1.7) (Figure 3), and VA-ECMO was performed as an initial intervention in 7.1% (184/2,625, 95% CI 4.7-9.9). Preoperative hemodynamic measurements showed higher pulmonary vascular resistance, mean pulmonary arterial pressure, and lower cardiac output in the ECMO group. Mortality rates were 2.8% (32/1238, 95% CI: 1.7-4.5) in the non-ECMO group and 43.5% (115/225, 95% CI: 30.8-56.2) in the ECMO group. The proportion of patients with successful weaning of ECMO was 72.6% (111/188, 95% CI: 53.4-91.7). Regarding complications of ECMO, the incidence of bleeding and multi-organ failure were 12.2% (16/79, 95% CI: 13.0-34.8) and 16.5% (15/99, 95% CI: 9.1-28.1), respectively. Conclusion: Our systematic
review showed a higher baseline cardiopulmonary risk in patients with perioperative ECMO in PEA, and its insertion rate was 8.7%. Further studies that compare the use of ECMO in high-risk patients who undergo PEA are anticipated.