Critical care (London, England) · 2026
Hemoperfusion during extracorporeal membrane oxygenation: an updated systematic review and meta-analysis of 8,151 patients.
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Xie Ting, Yang Chengyi, Tao Heng, Yang Xueting, Deng Lei, Zeng Jun, Jiang Hua, Zhou Ping
Аннотация
BACKGROUND: This systematic review and meta-analysis evaluated the clinical efficacy and safety of hemoperfusion in adults receiving extracorporeal membrane oxygenation (ECMO).
METHODS: We systematically searched PubMed, Embase, the Cochrane Library, CNKI, and CBM for studies comparing ECMO plus hemoperfusion (ECMO + HP) with ECMO alone in adult patients. The primary outcome was all-cause mortality. Prespecified subgroup analyses were conducted according to study design (RCT vs non-RCT), ECMO type (VA vs VV), and etiology (cardiogenic shock vs cardiac arrest). Risk of bias was assessed using RoB 2.0 and ROBINS-I, and Trial Sequential Analysis (TSA) was performed. The systematic review was registered with PROSPERO (CRD42025643149) and conducted in accordance with PRISMA guidelines.
RESULTS: Thirteen studies involving 8,151 patients were included, comprising three RCTs and ten non-RCTs. Overall, ECMO + HP did not significantly reduce all-cause mortality compared with ECMO alone (OR 0.98, 95% CI 0.49-1.94; P = 0.95; I2 = 76%). However, mortality was higher with ECMO + HP in RCTs (OR 4.96, 95% CI 1.67-14.77; P = 0.004; I2 = 34%), whereas no significant difference was observed in non-RCTs (OR 0.58, 95% CI 0.25-1.33; P = 0.20; I2 = 79%). Subgroup analyses by ECMO type showed no survival benefit with either VA-ECMO (OR 0.80, 95% CI 0.41-1.58; P = 0.53; I2 = 47%) or VV-ECMO (OR 1.23, 95% CI 0.30-4.99; P = 0.77; I2 = 77%). Among VA-ECMO patients, etiology-based analyses showed no mortality benefit in cardiogenic shock (OR 0.58, 95% CI 0.31-1.09; P = 0.09; I2 = 22%) or cardiac arrest (OR 2.42, 95% CI 0.71-8.25; P = 0.16; I2 = 26%). No significant differences were identified in other clinical outcomes or complications, and TSA indicated that the evidence remains insufficient to confirm a mortality benefit. Most studies were at moderate to serious risk of bias.
CONCLUSION: In patients receiving extracorporeal membrane oxygenation, hemoperfusion did not reduce mortality and may be associated with increased mortality in randomized controlled trials. Current evidence does not support routine use of ECMO + HP in ICU condition.
METHODS: We systematically searched PubMed, Embase, the Cochrane Library, CNKI, and CBM for studies comparing ECMO plus hemoperfusion (ECMO + HP) with ECMO alone in adult patients. The primary outcome was all-cause mortality. Prespecified subgroup analyses were conducted according to study design (RCT vs non-RCT), ECMO type (VA vs VV), and etiology (cardiogenic shock vs cardiac arrest). Risk of bias was assessed using RoB 2.0 and ROBINS-I, and Trial Sequential Analysis (TSA) was performed. The systematic review was registered with PROSPERO (CRD42025643149) and conducted in accordance with PRISMA guidelines.
RESULTS: Thirteen studies involving 8,151 patients were included, comprising three RCTs and ten non-RCTs. Overall, ECMO + HP did not significantly reduce all-cause mortality compared with ECMO alone (OR 0.98, 95% CI 0.49-1.94; P = 0.95; I2 = 76%). However, mortality was higher with ECMO + HP in RCTs (OR 4.96, 95% CI 1.67-14.77; P = 0.004; I2 = 34%), whereas no significant difference was observed in non-RCTs (OR 0.58, 95% CI 0.25-1.33; P = 0.20; I2 = 79%). Subgroup analyses by ECMO type showed no survival benefit with either VA-ECMO (OR 0.80, 95% CI 0.41-1.58; P = 0.53; I2 = 47%) or VV-ECMO (OR 1.23, 95% CI 0.30-4.99; P = 0.77; I2 = 77%). Among VA-ECMO patients, etiology-based analyses showed no mortality benefit in cardiogenic shock (OR 0.58, 95% CI 0.31-1.09; P = 0.09; I2 = 22%) or cardiac arrest (OR 2.42, 95% CI 0.71-8.25; P = 0.16; I2 = 26%). No significant differences were identified in other clinical outcomes or complications, and TSA indicated that the evidence remains insufficient to confirm a mortality benefit. Most studies were at moderate to serious risk of bias.
CONCLUSION: In patients receiving extracorporeal membrane oxygenation, hemoperfusion did not reduce mortality and may be associated with increased mortality in randomized controlled trials. Current evidence does not support routine use of ECMO + HP in ICU condition.