The following is a summary of “Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis,” published in the April 2024 issue of Critical Care by Stommel et al.
Researchers conducted a retrospective study investigating the effect of extracorporeal carbon dioxide removal (ECCO2R) on gas exchange and respiratory settings in critically ill adults with respiratory failure.
They undertook an extensive database search, encompassing observational studies and RCTs (January 2000 to March 2022), focusing on adult ICU patients receiving ECCO2R. Primary outcomes included alterations in gas exchange and ventilator settings 24 hours after ECCO2R initiation, represented as mean differences or proportions for AEs, with subgroup analyses for disease indication and technology. Across RCTs, mortality, length of stay, ventilation days, and AEs were evaluated as mean differences or ORs.
The results showed that 49 studies involving 1,672 patients were included. ECCO2R led to a notable decrease in PaCO2, plateau pressure and tidal volume, and an increase in pH across all patient groups, with an overall 19% adverse event rate. In ARDS and patients with lung transplant, the PaO2/FiO2 ratio significantly improved while ventilator settings varied. Systems with “higher extraction” more effectively reduced PaCO2 and respiratory rate. Among the three available RCTs, there was no impact on mortality, but ECCO2R was linked to significantly more prolonged ICU and hospital stays.
Investigators concluded that ECCO2R effectively reduced PaCO2 and acidosis, potentially enabling less invasive ventilation, but its effect on mortality remains unclear due to increased adverse events in RCTs, highlighting the need for targeted patient studies.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04927-x