Extracorporeal Life Support Use During Severe Anaphylaxis: A Systematic Review and Pooled Analysis of Individual Patient Data.

OBJECTIVE

Severe anaphylaxis is a rare but life-threatening condition that may require extracorporeal life support (ECLS). A systematic review was conducted to evaluate the outcomes of patients receiving ECLS for severe anaphylaxis.

DESIGN AND

SETTING

A medical librarian searched six databases (2000-present) for studies reporting ECLS use in severe anaphylaxis, without language or design restrictions. Outcomes included survival, neurologic recovery, and ECLS-related complications. Data extraction was performed in duplicate, risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions-I and Joanna Briggs Institute tools, and event rates were estimated using Bayesian mixed-effects logistic regression. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation guidelines.

PARTICIPANTS

Patients hospitalized due to anaphylactic shock.

INTERVENTIONS: The use of ECLS in patients suffering severe anaphylaxis.

MEASUREMENTS AND MAIN

RESULTS

A total of 50 studies describing 78 patients were included. Most underwent venoarterial extracorporeal membrane oxygenation (72%), 53% underwent cardiopulmonary resuscitation, and medications were the most common trigger (60.2%). The pooled survival rate was 85.9% (95% confidence interval [CI]: 77.0-92.9), with favorable neurologic outcomes in 86.3% (95% CI: 77.5-93.8) of survivors and a complication rate of 11.0% (95% CI: 2.4-21.9). The risk of bias was high, and the certainty of the evidence was low.

CONCLUSIONS

ECLS may provide meaningful survival and neurologic benefits in severe anaphylaxis, though complications are frequent and evidence remains limited. Larger studies are needed to better define its role in anaphylaxis management.