A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation

Wohlfarth, Philipp; Schellongowski, Peter; Staudinger, Thomas; Rabitsch, Werner; Hermann, Alexander; Buchtele, Nina; Turki, Amin T.; Tzalavras, Asterios; Liebregts, Tobias

doi:10.1111/aor.13931

Cited by 4 publications

(2 citation statements)

References 37 publications

(138 reference statements)

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“…Additional file 1 : Table S3 shows the parameters available for each included study. Risk of bias assessment (Robins-I tool) revealed 4 studies with a low risk [ 31 , 34 – 36 ], 14 with moderate risk [ 6 , 8 , 19 , 30 , 33 , 37 – 44 ], and 30 with serious risk [ 4 , 18 , 21 – 29 , 32 , 45 – 60 ]. Three studies were categorized as critical risk [ 61 – 63 ] (Additional file 1 : Figure S1).…”

Section: Resultsmentioning

confidence: 99%

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Stommel,

Herkner,

Kienbacher

et al. 2024

Crit Care

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Purpose A systematic review and meta-analysis to evaluate the impact of extracorporeal carbon dioxide removal (ECCO2R) on gas exchange and respiratory settings in critically ill adults with respiratory failure. Methods We conducted a comprehensive database search, including observational studies and randomized controlled trials (RCTs) from January 2000 to March 2022, targeting adult ICU patients undergoing ECCO2R. Primary outcomes were changes in gas exchange and ventilator settings 24 h after ECCO2R initiation, estimated as mean of differences, or proportions for adverse events (AEs); with subgroup analyses for disease indication and technology. Across RCTs, we assessed mortality, length of stay, ventilation days, and AEs as mean differences or odds ratios. Results A total of 49 studies encompassing 1672 patients were included. ECCO2R was associated with a significant decrease in PaCO2, plateau pressure, and tidal volume and an increase in pH across all patient groups, at an overall 19% adverse event rate. In ARDS and lung transplant patients, the PaO2/FiO2 ratio increased significantly while ventilator settings were variable. “Higher extraction” systems reduced PaCO2 and respiratory rate more efficiently. The three available RCTs did not demonstrate an effect on mortality, but a significantly longer ICU and hospital stay associated with ECCO2R. Conclusions ECCO2R effectively reduces PaCO2 and acidosis allowing for less invasive ventilation. “Higher extraction” systems may be more efficient to achieve this goal. However, as RCTs have not shown a mortality benefit but increase AEs, ECCO2R’s effects on clinical outcome remain unclear. Future studies should target patient groups that may benefit from ECCO2R. PROSPERO Registration No: CRD 42020154110 (on January 24, 2021). Graphical abstract

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Section: Resultsmentioning

confidence: 99%

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Stommel,

Herkner,

Kienbacher

et al. 2024

Crit Care

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“…To date, there is little data on the frequency of use of extracorporeal lung assist devices in HSCT recipients. Two centers also involved in this study recently analyzed the use of ECCO2R systems and reported their use in 3.4% of all critically ill HSCT recipients during the observation period [18].…”

Section: Discussionmentioning

confidence: 99%

Impact of chronic graft-versus-host-disease on intensive care outcome in allogeneic hematopoietic stem cell recipients

Lueck

Tzalavras

Wohlfarth

et al. 2022

Bone Marrow Transplant

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Chronic graft-vs-host-disease (cGvHD) is the most relevant long-term complication after allogeneic stem cell transplantation (HSCT) with major impact on non-relapse mortality, but data on intensive care unit (ICU) outcome are missing. In this retrospective, multicenter study we analyzed 174 adult HSCT recipients with cGvHD requiring intensive care treatment. Skin, pulmonary, liver, and intestinal involvement were present in 76.7%, 47.1%, 38.1% and 24.1%, respectively, and a total of 63.2% had severe cGvHD. Main reasons for ICU admission were respiratory failure (69.7%) and sepsis (34.3%). Hospital- and 3-year OS rates were 51.7% and 28.6%, respectively. Global severity of cGvHD did not impact short- and long-term survival. However, patients with severe liver cGvHD or the overlap subtype had a reduced hospital survival, while severe pulmonary cGvHD was associated with worse long-term survival. In multivariate analysis need for invasive ventilation (HR 1.08 (95% CI 1.02–1.14)) or hemodialysis (HR 1.73 (95% CI 1.14–2.62)) and <1 year since HSCT (HR 1.56 (95% CI 1.03–2.39)) were independently associated with a poorer survival. While the global severity of cGvHD does not per se affect patients’ survival after intensive care treatment, pre-existing severe hepatic, intestinal or pulmonary cGvHD is associated with worse outcomes.

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Role of the intensive care in allogeneic hematopoietic stem cell transplantation

Shchekina¹,

Galstyan²,

Drokov³

2022

Gematologiâ i transfuziologiâ

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Introduction. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often complicated by life-threatening conditions.Aim — an analysis of the life-threatening complications in recipients of allogeneic hematopoietic stem cells (allo-HSCs)Main findings. From 10 to 50 % of allo-HSC recipients need to be admitted to the intensive care unit (ICU) due to the development of life-threatening complications. The reasons for ICU admission are acute respiratory failure, sepsis, graft-versus-host disease, veno-occlusive disease, thrombotic microangiopathy, cytokine release syndrome, engraftment syndrome, etc. Conditioning regimen, donor type, stem cell source, underlying disease state and patient comorbidity are the risk factors associated with development of life-threatening conditions. The main prognostic factors of unfavorable ICU outcomes in allo-HSC recipients are the severity of multiple organ dysfunction and the need for organ support.

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A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO₂R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation

Cited by 4 publications

References 37 publications

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Impact of chronic graft-versus-host-disease on intensive care outcome in allogeneic hematopoietic stem cell recipients

Role of the intensive care in allogeneic hematopoietic stem cell transplantation

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A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO2R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation

Cited by 4 publications

References 37 publications

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis

Impact of chronic graft-versus-host-disease on intensive care outcome in allogeneic hematopoietic stem cell recipients

Role of the intensive care in allogeneic hematopoietic stem cell transplantation

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A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO₂R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation