背景:年龄作为V-VECMO的资格标准是广泛争论的,并且在医疗机构中有所不同。我们研究了接受V-VECMO治疗的ARDS患者的年龄与死亡率的关系。
方法:2015年至2024年6月发表的临床研究的系统评价和荟萃回归。涉及至少6例接受V-VECMO治疗的ARDS患者的研究,纳入了ICU和/或住院死亡率和患者年龄的具体数据.搜索策略是在PubMed中执行的,仅限于英语。分别分析了COVID-19和非COVID-19人群。使用性别,BMI,SAPSII,APACHEII,Charlson合并症指数或SOFA为协变量。
结果:在非COVIDARDS中,对173项研究和56,257名参与者进行的meta回归显示,平均年龄与ICU/医院死亡率之间存在显著正相关.在COVID-19ARDS中,平均年龄与ICU死亡率之间存在显著关系,但不是医院死亡率,在103项研究中发现,有21,255名参与者。敏感性分析证实了这些发现,强调两组年龄和死亡率之间的线性关系。平均年龄每增加一年,非COVIDARDS的ICU死亡率增加了1.2%,COVIDARDS的ICU死亡率增加了1.9%。
结论:年龄与ICU死亡率呈线性关系,无拐点。因此,在确定患者是否符合V-VECMO条件时,不建议采用年龄截止法.
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.