A Systematic Review and Meta-analysis Unveiling the Pivotal Role of Extracorporeal Membrane Oxygenation (ECMO) in Drug Overdose Treatment Optimization

Abstract

Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.Methods: From inception until April 30, 2024, an extensive search was performed on four main databases:PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Onlythe studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLSin the treatment of intoxicated patients were included. On the other hand, articles that did not report adverseevents or hospital discharge rates as outcomes, as well as studies published in languages other than English,were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidenceof adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise eachstudy to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among thestudies) and a 95% confidence interval.Results: From a total search of 2216 search results, only 10 studies were included. The pooled analysis from10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated witha significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], p=0.030). However, theoutcomes were highly heterogeneous (I2=83.47%), which could be attributed to the use of several medicinesby different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with asignificant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], p=0.002). However, the pooledanalysis had a significant heterogeneity (I2=70.27%).Conclusion: Despite various health complications, extracorporeal membrane treatment enhanced survival tohospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternativefor managing drug-induced intoxication in patients.

Keywords

• extracorporeal treatment
• ecmo therapies
• ecls
• drug-overdose
• poisoning