scholarly journals Role of extracorporeal membrane oxygenation in children with sepsis: a systematic review and meta-analysis

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Kollengode Ramanathan ◽  
Nicholas Yeo ◽  
Peta Alexander ◽  
Lakshmi Raman ◽  
Ryan Barbaro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Extracorporeal Membrane Oxygenation ◽  
Survival Data ◽  
Meta Analysis ◽  
Survival Rates ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Gram Positive ◽  
Membrane Oxygenation

Abstract Background The benefits of extracorporeal membrane oxygenation (ECMO) in children with sepsis remain controversial. Current guidelines on management of septic shock in children recommend consideration of ECMO as salvage therapy. We sought to review peer-reviewed publications on effectiveness of ECMO in children with sepsis. Methods Studies reporting on mortality in children with sepsis supported with ECMO, published in PubMed, Scopus and Embase from 1972 till February 2020, were included in the review. This study was done in adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis statement after registering the review protocol with PROSPERO. Study eligibility was independently assessed by two authors and disagreements resolved by a third author. Publications were reviewed for quality using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Random-effects meta-analyses (DerSimonian and Laird) were conducted, and 95% confidence intervals were computed using the Clopper-Pearson method. Outliers were identified by the Baujat plot and leave-one-out analysis if there was considerable heterogeneity. The primary outcome measure was survival to discharge. Secondary outcome measures included hospital length of stay, subgroup analysis of neonatal and paediatric groups, types and duration of ECMO and complications . Results Of the 2054 articles screened, we identified 23 original articles for systematic review and meta-analysis. Cumulative estimate of survival (13 studies, 2559 patients) in the cohort was 59% (95%CI: 51–67%). Patients had a median length of hospital stay of 28.8 days, median intensive care unit stay of 13.5 days, and median ECMO duration of 129 h. Children needing venoarterial ECMO (9 studies, 208 patients) showed overall pooled survival of 65% (95%CI: 50–80%). Neonates (< 4 weeks of age) with sepsis needing ECMO (7 studies, 85 neonates) had pooled survival of 73% (95%CI: 56- 87%). Gram positive organisms were the most common pathogens (47%) in septic children supported with ECMO. Conclusion Survival rates of children with sepsis needing ECMO was 59%. Neonates had higher survival rates (73%); gram positive organisms accounted for most common infections in children needing ECMO. Despite limitations, pooled survival data from this review indicates consideration of ECMO in refractory septic shock for all pediatric age groups.

Extracorporeal Membrane Oxygenation Utilization in Blunt and Penetrating Traumatic Injuries: A Systematic Review

2021 ◽  
pp. 000313482110111
Author(s):  
Haley Ehrlich, BS ◽  
Charlie Bisbee, BS ◽  
Aleeza Ali ◽  
Dino Fanfan, BS ◽  
Sabrina Gill, BS ◽  
...  
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Meta Analysis ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Neurological Deficits ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Severity Scores

Background Extracorporeal membrane oxygenation (ECMO) has become an increasingly used treatment modality for severe respiratory insufficiency in trauma patients. Examining ECMO use specifically in blunt and penetrating traumas can aid in directing future protocols. We aim to evaluate the outcomes of ECMO use in both blunt and penetrating trauma patients through a systematic review of current literature. Methods An online search of 2 databases (PubMed and Google Scholar) was performed to analyze studies, which evaluated the use of ECMO in blunt and penetrating traumas. Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Grading of Recommendations Assessment, Development and Evaluation guidelines were followed. Data extracted included mechanism of injury, injury severity scores (ISSs), complications, and mortality rates. Results The search demonstrated 9 studies that met our review inclusion criteria. A total of 207 patients were included, of which 64 (30.9%) were non-survivors and 143 (69.1%) were survivors. There was a total of 201 blunt traumas with 61 (30.3%) deaths, whereas penetrating traumas had 2 deaths (33.3%) out of 6 total patients. Complications reported included acute renal failure, hemorrhage at the cannula site, and transient neurological deficits. Most studies found better survival rates and less complications in younger patients and those with lower ISS. Conclusion Expanding the use of ECMO to include blunt and penetrating trauma patients provides the trauma surgeons with another crucial potentially lifesaving tool with an overall survival rate of 70%. Anticipating increased future use of ECMO in blunt and penetrating trauma patients, distinct protocols ought to be instilled to better address the care needed for these critically ill trauma patients.

scholarly journals Prevalence of the Genus Propionibacterium in Primary and Persistent Endodontic Lesions: A Systematic Review

2020 ◽  
Vol 9 (3) ◽  
pp. 739 ◽  
Author(s):  
Mario Dioguardi ◽  
Mario Alovisi ◽  
Vito Crincoli ◽  
Riccardo Aiuto ◽  
Giancarlo Malagnino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Propionibacterium Acnes ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Exclusion Criteria ◽  
Gram Positive ◽  
Gram Positive Bacteria ◽  
Endodontic Infections ◽  
Outcome Differences ◽  
Present Systematic Review

Propionibacterium are anaerobic/aero-tolerant rod Gram-positive bacteria, and numerous studies are associated with primary and secondary endodontic infections. The data in the literature on the prevalence of Propionibacterium are conflicting, and there are studies that report conflicting data on the prevalence in primary and secondary endodontic infections. This review aims to clarify the prevalence of bacteria of the genus Propionibacterium in endodontic lesions. The present systematic review work was performed on the basis of the Prisma protocol. A search was carried out on the PubMed and Scopus databases with the use of keywords. The research produced 410 records, which, after the elimination of the overlaps and the application of the inclusion and exclusion criteria, led to a number of 36 included articles divided by the three outcomes. The first outcome concerns prevalence of bacteria of the genus Propionibacterium in primary and secondary endodontic lesions. The secondary outcome, differences in the prevalence of bacteria of the genus Propionibacterium between primary endodontic infections and secondary endodontic infections. The tertiary outcome, differences in the prevalence of Propionibacterium Acnes compared to Propionibacterium propionicum in endodontic infections. The results of the meta-analysis show that the genus Propionibacterium bacteria are more prevalent in secondary endodontic infections and that P. acnes has a higher prevalence than P. propionicum.

Efficacy of Distal Perfusion Cannulae in Preventing Limb Ischemia During Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 41 (11) ◽  
pp. E263-E273 ◽  
Author(s):  
Yen-Yi Juo ◽  
Matthew Skancke ◽  
Yas Sanaiha ◽  
Aditya Mantha ◽  
Juan C. Jimenez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Meta Analysis ◽  
Limb Ischemia ◽  
Membrane Oxygenation ◽  
Distal Perfusion

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

Critical Care ◽  
2013 ◽  
Vol 17 (1) ◽  
pp. R30 ◽  
Author(s):  
Alberto Zangrillo ◽  
Giuseppe Biondi-Zoccai ◽  
Giovanni Landoni ◽  
Giacomo Frati ◽  
Nicolò Patroniti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Influenza Infection ◽  
Meta Analysis ◽  
H1n1 Influenza ◽  
Membrane Oxygenation

scholarly journals Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Jing Xiong ◽  
Li Zhang ◽  
Lei Bao
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Membrane Oxygenation ◽  
Venovenous Ecmo ◽  
Complications And Mortality ◽  
Overall Mortality

Abstract Background: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO in the treatment of neonatal respiratory failure, we performed a systematic review and meta-analysis of all the related studies. Methods: PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results: Four observational studies were included, with a total of 347 newborns. The overall mortality at hospital charge was 12% (5% - 18%) with a heterogeneity of I2 = 73.8% (p = 0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8% -19.2%) and 6.1% (2.6% - 9.6%) respectively. The most common complications associated with venovenous ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion: The overall mortality at discharge of venovenous ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples and higher quality of randomized controlled trials (RCT) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.

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