Extracorporeal Carbon Dioxide Removal in Patients with Acute Respiratory Distress Syndrome or Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Extracorporeal carbon dioxide removal (ECCO2R) was used to prevent invasive mechanical ventilation and associated mechanical damage in patients with acute respiratory distress syndrome (ARDS).This study aimed to investigate the efficacy and safety of ECCO2R treatment in patients with ARDS or chronic obstructive pulmonary disease (COPD).MEDLINE, EMBASE, and the Cochrane Library were systematically searched for relevant studies that reported patient prognosis, blood gas parameters, and ECCO2R-related adverse events (AEs) published as of September 2020. Odds ratios (ORs), weighted mean differences (WMDs), and their corresponding 95% confidence intervals (CIs) were used to compare the outcomes.Fifteen studies involving 532 ARDS or COPD patients were included. Compared with controls, ECCO2R did not influence the 28-day mortality (OR = 0.73, 95% CI: 0.28-1.87, p = 0.51), the length of hospital stay (WMD = 3.34, 95% CI: -5.22 to 11.90, p = 0.444), and the length of intensive care unit stay (WMD = -0.39, 95% CI: -8.76 to 7.99, p = 0.928). Compared with baseline values, partial pressure of carbon dioxide (PaCO2) in the ECCO2R group was significantly reduced, while the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and pH increased. The overall rate of ECCO2R-related AEs was 35% (95% CI: 17-53%, p < 0.001), and bleeding was the most common AE with a rate of 22% (95% CI: 13-31%, p = 0.002). The rate of ECCO2R-related deaths was low.In conclusion, there was no statistically significant difference in the prognosis of patients with and without ECCO2R treatment. ECCO2R significantly reduced PaCO2 and improved PaO2/FiO2 and pH values in patients with ARDS or COPD. Bleeding was the most common ECCO2R-related AE.