ABSTRACT
Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) on critical patients with non-pulmonary primary disease in the emergency department. Methods The literature of English and Chinese clinical studies on the ECMO treating critical patients with non-pulmonary primary disease published before August 2017 were electronically searched on PubMed, Embase and other databases. The obtained articles were selected, their qualities were strictly evaluated, and the in-hospital survival rate, 3-month, 6-month and 1-year survival rate, as well as the average intensive care unit (ICU) and length of hospital stay were extracted. This meta-analysis were performed using RevMan software (Version 5.0, Cochrane collaboration). Results A total of 11 articles (n=3043) were enrolled including 616 cases of ECMO treatment group and 2427 cases of control group. Fitting results showed that compared with the traditional treatment, application of ECMO can improve the in-hospital survival rate[52.1％(321/616) vs. 32.1％ (780/2427); OR=2.02; 95％CI:1.11-3.67, P=0.02] and the survival rate more than 90 days[42.1％ (61/145) vs. 17.1％ (38/222); OR=3.98; 95％CI:2.30-6.89, P<0.01];and prolong the average length of hospital stay (MD=-5.35, 95％CI:-8.10--2.60, P<0.01) and ICU time(MD=-8.99, 95％CI:-8.20--1.80, P<0.01). Conclusions Meta-analysis of existing studies showed that application of ECMO can improve the short-term and long-term prognosis of critical patients with non-pulmonary primary disease. However, due to the small number of studies and the large heterogeneity of the study population, it is necessary to carry out more, large samples and high quality randomized controlled clinical trials.
ABSTRACT
Objective To investigate the epidemiological characteristics of emergency critical illness and disease spectrum in emergency department of a hospital in Beijing. Methods A retrospective study was conducted. The data of 3 176 critically ill patients aged ≥ 14 years old admitted to the emergency room of Xuanwu Hospital Capital Medical University from January 1st to December 31st in 2017 were analyzed, including gender, age, clinical time, discharge diagnosis, outcomes, etc. To analyze the epidemiological characteristics and disease spectrum distribution of emergency critically ill patients, annual and daily 24-hour emergency visits in 2017 were analyzed. Results Among the 3 176 cases of acute critical illness, there were more males than females (1 824 vs. 1 352, 1.35 : 1); the age ranged from 14 to 100 years old, with an average of (66.52±17.18) years old; the highest incidence age was 75-89 years old (35.2%, 516 males and 603 females), followed by 60-70 years old (30.0%, 572 males and 381 females). The top four prevalence diseases in the emergency critical disease spectrum were cardiovascular diseases [41.8%, 716 males and 610 females, age (70.25±15.08) years old], nervous system diseases [26.7%, 502 males and 346 females, age (60.28±17.57) years old], respiratory disease [12.3%, 226 males and 166 females, age (72.96±16.23) years old] and digestive system diseases [5.6%, 119 males and 60 females, age (65.40±17.96) years old], accounting for 86.4% of the total. There were more males than females (all P < 0.05), and the age difference was statistically significant (F = 84.094, P < 0.001). Arrhythmia was the most common cardiovascular disease (16.7%), followed by acute coronary syndrome (12.0%) and heart failure (9.1%); the main nervous system diseases were stroke (20.9%); respiratory diseases mainly included severe pneumonia (8.3%); digestive system diseases were mainly with digestive tract bleeding (4.4%). The high incidence of acute critical illness in the emergency department occurred in winter (287 cases in December and 277 cases in January) and the early stage of spring (282 cases in March). The daily peak period was midday and at night, especially from 18:00 to 23:00 (163 cases at 18:00, 173 cases at 19:00, 172 cases at 20:00, 186 cases at 21:00, 167 cases at 22:00, 169 cases at 23:00). The average treatment time of critically ill patients in emergency room was 1.5 days (the longest was 23.0 days, the shortest was 6 minutes), among them, 85.6% of the patients could be discharged from the emergency within 3 days, and 1.9% of the patients stayed in the emergency for more than 7 days. There were 305 deaths (9.6%), mainly among the elderly, with an average age of (71.10±16.08) years old. Conclusions Cardiovascular and cerebrovascular diseases, respiratory and digestive diseases are the main causes of acute critical diseases in department of emergency of Xuanwu Hospital Capital Medical University in 2017. Male and elderly patients are more common; different types of acute and severe patients tend to attack at different ages.