Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis
Purpose: To assess the safety and efficacy of extracorporeal carbon dioxide removal (ECCO2R) versus standard care in patients with acute hypoxaemic respiratory failure (AHRF). Methods: MEDLINE, Embase and clinical trial registries were searched from 1994 to 31 December 2021. We included randomised c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2022-11-01
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| Series: | European Respiratory Review |
| Online Access: | http://err.ersjournals.com/content/31/166/220030.full |
| _version_ | 1797961081785679872 |
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| author | Jonathan E. Millar Andrew J. Boyle Thomas M. Drake Claire E. Adams Adam W. Glass Bronagh Blackwood James J. McNamee Daniel F. McAuley |
| author_facet | Jonathan E. Millar Andrew J. Boyle Thomas M. Drake Claire E. Adams Adam W. Glass Bronagh Blackwood James J. McNamee Daniel F. McAuley |
| author_sort | Jonathan E. Millar |
| collection | DOAJ |
| description | Purpose:
To assess the safety and efficacy of extracorporeal carbon dioxide removal (ECCO2R) versus standard care in patients with acute hypoxaemic respiratory failure (AHRF).
Methods:
MEDLINE, Embase and clinical trial registries were searched from 1994 to 31 December 2021. We included randomised controlled trials (RCTs) and observational studies. Pairs of reviewers independently extracted data and assessed the risk of bias. The primary outcome was mortality. Secondary outcomes included ventilator-free days, length of stay, safety and adverse events and physiological changes. As a primary analysis, we performed a meta-analysis of mortality until day 30 using a Bayesian random effects model. We then performed a trial sequential analysis of RCTs.
Results:
21 studies met inclusion criteria: three RCTs, enrolling 531 patients, and 18 observational studies. In a pooled analysis of RCTs, the posterior probability of increased mortality with the use of ECCO2R was 73% (relative risk 1.19, 95% credible interval 0.70–2.29). There was substantial heterogeneity in the reporting of safety and adverse events. However, the incidence of extra and intracranial haemorrhage was higher (relative risk 3.00, 95% credible interval 0.41–20.51) among those randomised to ECCO2R. Current trials have accumulated 80.8% of the diversity-adjusted required information size and the lack of effect reaches futility for a 10% absolute risk reduction in mortality.
Conclusions:
The use of ECCO2R in patients with AHRF is not associated with improvements in clinical outcomes. Furthermore, it is likely that further trials of ECCO2R aiming to achieve an absolute risk reduction in mortality of ≥10% are futile. |
| first_indexed | 2024-04-11T00:53:48Z |
| format | Article |
| id | doaj.art-df28876478e540859b297401bf213998 |
| institution | Directory Open Access Journal |
| issn | 0905-9180 1600-0617 |
| language | English |
| last_indexed | 2024-04-11T00:53:48Z |
| publishDate | 2022-11-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | European Respiratory Review |
| spelling | doaj.art-df28876478e540859b297401bf2139982023-01-05T07:48:22ZengEuropean Respiratory SocietyEuropean Respiratory Review0905-91801600-06172022-11-013116610.1183/16000617.0030-20220030-2022Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysisJonathan E. Millar0Andrew J. Boyle1Thomas M. Drake2Claire E. Adams3Adam W. Glass4Bronagh Blackwood5James J. McNamee6Daniel F. McAuley7 Roslin Institute, University of Edinburgh, Edinburgh, UK Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK Academic Unit of Anaesthesia, Critical Care, and Peri-operative Medicine, University of Glasgow, Glasgow, UK Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK Purpose: To assess the safety and efficacy of extracorporeal carbon dioxide removal (ECCO2R) versus standard care in patients with acute hypoxaemic respiratory failure (AHRF). Methods: MEDLINE, Embase and clinical trial registries were searched from 1994 to 31 December 2021. We included randomised controlled trials (RCTs) and observational studies. Pairs of reviewers independently extracted data and assessed the risk of bias. The primary outcome was mortality. Secondary outcomes included ventilator-free days, length of stay, safety and adverse events and physiological changes. As a primary analysis, we performed a meta-analysis of mortality until day 30 using a Bayesian random effects model. We then performed a trial sequential analysis of RCTs. Results: 21 studies met inclusion criteria: three RCTs, enrolling 531 patients, and 18 observational studies. In a pooled analysis of RCTs, the posterior probability of increased mortality with the use of ECCO2R was 73% (relative risk 1.19, 95% credible interval 0.70–2.29). There was substantial heterogeneity in the reporting of safety and adverse events. However, the incidence of extra and intracranial haemorrhage was higher (relative risk 3.00, 95% credible interval 0.41–20.51) among those randomised to ECCO2R. Current trials have accumulated 80.8% of the diversity-adjusted required information size and the lack of effect reaches futility for a 10% absolute risk reduction in mortality. Conclusions: The use of ECCO2R in patients with AHRF is not associated with improvements in clinical outcomes. Furthermore, it is likely that further trials of ECCO2R aiming to achieve an absolute risk reduction in mortality of ≥10% are futile.http://err.ersjournals.com/content/31/166/220030.full |
| spellingShingle | Jonathan E. Millar Andrew J. Boyle Thomas M. Drake Claire E. Adams Adam W. Glass Bronagh Blackwood James J. McNamee Daniel F. McAuley Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis European Respiratory Review |
| title | Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis |
| title_full | Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis |
| title_fullStr | Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis |
| title_full_unstemmed | Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis |
| title_short | Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis |
| title_sort | extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure a systematic review bayesian meta analysis and trial sequential analysis |
| url | http://err.ersjournals.com/content/31/166/220030.full |
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