ECMO for severe ARDS in adults: a rapid health technology assessment_Chinese Journal of Evidence-Based Medicine

Authors：

FAN Zhilei ^1,2 , YAN Juntao ^1,2 ,  CHEN Yingyao ^1,2

1. School of Public Health, Fudan University, Shanghai 200032, P.R. China;
2. NHC Key Lab of Health Technology Assessment (Fudan University), Shanghai 200032, P.R. China;

Corresponding?author：

CHEN Yingyao, Email: yychen@shmu.edu.cn

Keywords：

Extracorporeal membrane oxygenation; Acute respiratory distress syndrome; Rapid health technology assessment

DOI：

10.7507/1672-2531.202103164

Video：

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Objective We aimed to evaluate the comparative efficacy and cost-effectiveness of the ECMO versus mechanical ventilation through a rapid health technology assessment. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs), systematic reviews, meta-analyses, complete economic evaluations, and CRD database for HTA reports from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Descriptive analysis and summary were then performed. Results A total of 21 references were involved, including 2 HTA reports, 5 RCTs, 11 systematic reviews or meta-analyses, and 3 economic evaluations. The quality of the literature evidence was heterogenous, and only 2 RCTs of high quality were included for meta-analysis. The results showed that the difference of 60-day mortality between ECMO and mechanical ventilation was statistically significant (RR=0.73, 95%CI 0.57 to 0.92, P=0.007). The majority of recent meta-analysis literature showed that short-term mortality of ECMO treatment was lower than that of mechanically ventilated patients. The cost-effective literature from different countries all showed that it was cost-effective in their respective health system, however, the quality of the literature varied. Conclusions Current evidence shows that ECMO has better safety, effectiveness and cost-effectiveness for ARDS compared with mechanical ventilation. However, it still required to be verified by high-quality studies with a long-term follow-up. Validate conclusions are needed through rigorous health technology assessments.

Citation： FAN Zhilei, YAN Juntao, CHEN Yingyao. ECMO for severe ARDS in adults: a rapid health technology assessment. Chinese Journal of Evidence-Based Medicine, 2021, 21(9): 1075-1081. doi: 10.7507/1672-2531.202103164 Copy

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2.	Hong X, Xiong J, Feng Z, et al. Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19? Int J Infect Dis, 2020, 94: 78-80.
3.	國家衛生健康委辦公廳, 國家中醫藥管理局辦公室. 關于印發新型冠狀病毒肺炎診療方案(試行第七版)的通知. Available at: http://www.gov.cn/zhengce/zhengceku/2020-03/04/content_5486705.htm.
4.	Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA, 1979, 242(20): 2193-2196.
5.	Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med, 1994, 149(2 Pt 1): 295-305.
6.	Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet, 2009, 374(9698): 1351-1363.
7.	Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
8.	Li C, Hou X, Tong Z, et al. Extracorporeal membrane oxygenation programs for COVID-19 in China. Crit Care, 2020, 24(1): 317.
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11.	樊巧玲, 趙金金. 應用體外膜肺氧合(ECMO)治療重癥急性呼吸窘迫綜合征的觀察. 實用臨床護理學電子雜志, 2020, 5(14): 94, 114.
12.	Zampieri FG, Mendes PV, Ranzani OT, et al. Extracorporeal membrane oxygenation for severe respiratory failure in adult patients: a systematic review and meta-analysis of current evidence. J Crit Care, 2013, 28(6): 998-1005.
13.	Tramm R, Ilic D, Davies AR, et al. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev, 2015, (1): CD010381.
14.	Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults: fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg, 2016, 152(1): 20-32.
15.	Vaquer S, de Haro C, Peruga P, et al. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care, 2017, 7(1): 51.
16.	Tillmann BW, Klingel ML, Iansavichene AE, et al. Extracorporeal membrane oxygenation (ECMO) as a treatment strategy for severe acute respiratory distress syndrome (ARDS) in the low tidal volume era: a systematic review. J Crit Care, 2017, 41: 64-71.
17.	Munshi L, Walkey A, Goligher E, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med, 2019, 7(2): 163-172.
18.	Mendes PV, Melro LMG, Li HY, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis. Rev Bras Ter Intensiva, 2019, 31(4): 548-554.
19.	Combes A, Peek GJ, Hajage D, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med, 2020, 46(11): 2048-2057.
20.	劉松橋, 金輝, 黃英姿, 等. 體外膜肺氧合對成人急性呼吸窘迫綜合征患者預后影響的 Meta 分析和系統評價. 中華急診醫學雜志, 2011, 20(4): 355-359.
21.	蔡施霞, 劉松橋, 邱曉華, 等. 體外膜肺氧合對成人急性呼吸窘迫綜合征患者預后影響的薈萃分析. 中國危重病急救醫學, 2012, 24(2): 78-82.
22.	史家欣, 孫文逵, 徐瑾, 等. 體外膜肺氧合在成人嚴重呼吸衰竭中應用的系統評價. 國際呼吸雜志, 2012, 32(12): 914-918.
23.	Park M, Mendes PV, Zampieri FG, et al. The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis. Rev Bras Ter Intensiva, 2014, 26(3): 253-262.
24.	Barrett KA, Hawkins N, Fan E. Economic evaluation of venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Crit Care Med, 2019, 47(2): 186-193.
25.	CADTH. Extracorporeal membrane oxygenation for acute respiratory failure: a review of the clinical effectiveness and guidelines. Canadian Agency for Drugs and Technologies in Health, 2014: 186-193.

1. World Health Organization. Coronavirus disease (COVID-19) pandemic. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
2. Hong X, Xiong J, Feng Z, et al. Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19? Int J Infect Dis, 2020, 94: 78-80.
3. 國家衛生健康委辦公廳, 國家中醫藥管理局辦公室. 關于印發新型冠狀病毒肺炎診療方案(試行第七版)的通知. Available at: http://www.gov.cn/zhengce/zhengceku/2020-03/04/content_5486705.htm.
4. Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA, 1979, 242(20): 2193-2196.
5. Morris AH, Wallace CJ, Menlove RL, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med, 1994, 149(2 Pt 1): 295-305.
6. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet, 2009, 374(9698): 1351-1363.
7. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
8. Li C, Hou X, Tong Z, et al. Extracorporeal membrane oxygenation programs for COVID-19 in China. Crit Care, 2020, 24(1): 317.
9. 藍倩, 李壯江, 孫煦, 等. 體外膜肺氧合應用在捐獻器官移植中的倫理學意義. 中國醫學倫理學, 2015, 28(5): 741-744.
10. Extracorporeal Life Support Organization (ELSO). Available at: https://www.elso.org/Home.aspx.
11. 樊巧玲, 趙金金. 應用體外膜肺氧合(ECMO)治療重癥急性呼吸窘迫綜合征的觀察. 實用臨床護理學電子雜志, 2020, 5(14): 94, 114.
12. Zampieri FG, Mendes PV, Ranzani OT, et al. Extracorporeal membrane oxygenation for severe respiratory failure in adult patients: a systematic review and meta-analysis of current evidence. J Crit Care, 2013, 28(6): 998-1005.
13. Tramm R, Ilic D, Davies AR, et al. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev, 2015, (1): CD010381.
14. Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults: fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg, 2016, 152(1): 20-32.
15. Vaquer S, de Haro C, Peruga P, et al. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care, 2017, 7(1): 51.
16. Tillmann BW, Klingel ML, Iansavichene AE, et al. Extracorporeal membrane oxygenation (ECMO) as a treatment strategy for severe acute respiratory distress syndrome (ARDS) in the low tidal volume era: a systematic review. J Crit Care, 2017, 41: 64-71.
17. Munshi L, Walkey A, Goligher E, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med, 2019, 7(2): 163-172.
18. Mendes PV, Melro LMG, Li HY, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis. Rev Bras Ter Intensiva, 2019, 31(4): 548-554.
19. Combes A, Peek GJ, Hajage D, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med, 2020, 46(11): 2048-2057.
20. 劉松橋, 金輝, 黃英姿, 等. 體外膜肺氧合對成人急性呼吸窘迫綜合征患者預后影響的 Meta 分析和系統評價. 中華急診醫學雜志, 2011, 20(4): 355-359.
21. 蔡施霞, 劉松橋, 邱曉華, 等. 體外膜肺氧合對成人急性呼吸窘迫綜合征患者預后影響的薈萃分析. 中國危重病急救醫學, 2012, 24(2): 78-82.
22. 史家欣, 孫文逵, 徐瑾, 等. 體外膜肺氧合在成人嚴重呼吸衰竭中應用的系統評價. 國際呼吸雜志, 2012, 32(12): 914-918.
23. Park M, Mendes PV, Zampieri FG, et al. The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis. Rev Bras Ter Intensiva, 2014, 26(3): 253-262.
24. Barrett KA, Hawkins N, Fan E. Economic evaluation of venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Crit Care Med, 2019, 47(2): 186-193.
25. CADTH. Extracorporeal membrane oxygenation for acute respiratory failure: a review of the clinical effectiveness and guidelines. Canadian Agency for Drugs and Technologies in Health, 2014: 186-193.

Chinese Journal of Evidence-Based Medicine

ECMO for severe ARDS in adults: a rapid health technology assessment

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