Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis

Abstract

Background Respiratory and circulatory dysfunction are common complications and the leading causes of death among burn patients, especially in severe burns and inhalation injury. Recently, extracorporeal membrane oxygenation (ECMO) has been increasingly applied in burn patients. However, current clinical evidence is weak and conflicting. This study aimed to comprehensively evaluate the efficacy and safety of ECMO in burn patients. Methods A comprehensive search of PubMed, Web of Science and Embase from inception to 18 March 2022 was performed to identify clinical studies on ECMO in burn patients. The main outcome was in-hospital mortality. Secondary outcomes included successful weaning from ECMO and complications associated with ECMO. Meta-analysis, meta-regression and subgroup analyses were conducted to pool the clinical efficacy and identify influencing factors. Results Fifteen retrospective studies with 318 patients were finally included, without any control groups. The commonest indication for ECMO was severe acute respiratory distress syndrome (42.1%). Veno–venous ECMO was the commonest mode (75.29%). Pooled in-hospital mortality was 49% [95% confidence interval (CI) 41–58%] in the total population, 55% in adults and 35% in pediatrics. Meta-regression and subgroup analysis found that mortality significantly increased with inhalation injury but decreased with ECMO duration. For studies with percentage inhalation injury ≥50%, pooled mortality (55%, 95% CI 40–70%) was higher than in studies with percentage inhalation injury <50% (32%, 95% CI 18–46%). For studies with ECMO duration ≥10 days, pooled mortality (31%, 95% CI 20–43%) was lower than in studies with ECMO duration <10 days (61%, 95% CI 46–76%). In minor and major burns, pooled mortality was lower than in severe burns. Pooled percentage of successful weaning from ECMO was 65% (95% CI 46–84%) and inversely correlated with burn area. The overall rate of ECMO-related complications was 67.46%, and infection (30.77%) and bleedings (23.08%) were the two most common complications. About 49.26% of patients required continuous renal replacement therapy. Conclusions ECMO seems to be an appropriate rescue therapy for burn patients despite the relatively high mortality and complication rate. Inhalation injury, burn area and ECMO duration are the main factors influencing clinical outcomes.

Extracorporeal Organ Support for Burn-Injured Patients

“…A meta-analysis published in 2022 reported that burn patients with inhalation and revised Baux scores exceeding 90 had lower-than-predicted mortality when treated with ECMO [29]. Most recently, a meta-analysis of 15 retrospective studies including 318 burn patients with severe ARDS reported successfully weaning from ECMO in 67% of patients and hospital survival in 51% of patients; this is consistent with ECMO survival in the general intensive care population reported by the ELSO [30]. The majority of studies included in the metaanalyses mentioned above lacked control groups, which makes it difficult to make strong conclusions regarding the benefit of ECMO in the burn population.…”