Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature.

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    • Abstract:
      Despite the use of lung protective ventilation (LPV) strategies, a severe form of acute respiratory distress syndrome (ARDS) is unfortunately associated with high mortality rates, which sometimes exceed 60%. Recently, major technical improvements have been applied in extracorporeal life support (ECLS) systems, but as these techniques are costly and associated with very serious adverse events, high-quality evidence is needed before these techniques can become the "cornerstone" in the management of moderate to severe ARDS. Unfortunately, evaluation of previous randomized controlled and observational trials revealed major methodological issues. In this review, we focused on the most important clinical trials aiming at a final conclusion about the effectiveness of ECLS in moderate to severe ARDS patients. Totally, 20 published clinical studies were included in this review. Most studies have important limitations with regard to quality and design. In the 20 included studies (2,956 patients), 1,185 patients received ECLS. Of them, 976 patients received extracorporeal membrane oxygenation (ECMO) and 209 patients received extracorporeal carbon dioxide removal (ECCO2R). According to our results, ECLS use was not associated with a benefit in mortality rate in patients with ARDS. However, when restricted to higher quality studies, ECMO was associated with a significant benefit in mortality rate. Furthermore, in patients with H1N1, a potential benefit of ECLS in mortality rate was apparent. Until more high-quality data are derived, ECLS should be an option as a salvage therapy in severe hypoxemic ARDS patients. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Department of Anesthesiology and Intensive Care Medicine, General University Hospital of Patras, School of Medicine, University of Patras, Rion, 26504 Patras, Greece
      2Technological Educational Institute of Western Greece, Patras, Greece
    • ISSN:
      2314-6133
    • Accession Number:
      10.1155/2019/1035730
    • Accession Number:
      138862683
  • Citations
    • ABNT:
      ARETHA, D. et al. Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature. BioMed Research International, [s. l.], p. 1–11, 2019. DOI 10.1155/2019/1035730. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=a9h&AN=138862683&custid=s6224580. Acesso em: 12 dez. 2019.
    • AMA:
      Aretha D, Fligou F, Kiekkas P, Karamouzos V, Voyagis G. Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature. BioMed Research International. September 2019:1-11. doi:10.1155/2019/1035730.
    • APA:
      Aretha, D., Fligou, F., Kiekkas, P., Karamouzos, V., & Voyagis, G. (2019). Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature. BioMed Research International, 1–11. https://doi.org/10.1155/2019/1035730
    • Chicago/Turabian: Author-Date:
      Aretha, Diamanto, Fotini Fligou, Panagiotis Kiekkas, Vasilis Karamouzos, and Gregorios Voyagis. 2019. “Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature.” BioMed Research International, September, 1–11. doi:10.1155/2019/1035730.
    • Harvard:
      Aretha, D. et al. (2019) ‘Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature’, BioMed Research International, pp. 1–11. doi: 10.1155/2019/1035730.
    • Harvard: Australian:
      Aretha, D, Fligou, F, Kiekkas, P, Karamouzos, V & Voyagis, G 2019, ‘Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature’, BioMed Research International, pp. 1–11, viewed 12 December 2019, .
    • MLA:
      Aretha, Diamanto, et al. “Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature.” BioMed Research International, Sept. 2019, pp. 1–11. EBSCOhost, doi:10.1155/2019/1035730.
    • Chicago/Turabian: Humanities:
      Aretha, Diamanto, Fotini Fligou, Panagiotis Kiekkas, Vasilis Karamouzos, and Gregorios Voyagis. “Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature.” BioMed Research International, September 29, 2019, 1–11. doi:10.1155/2019/1035730.
    • Vancouver/ICMJE:
      Aretha D, Fligou F, Kiekkas P, Karamouzos V, Voyagis G. Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS—A Review and Meta-Analysis of the Literature. BioMed Research International [Internet]. 2019 Sep 29 [cited 2019 Dec 12];1–11. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=a9h&AN=138862683&custid=s6224580