Evidence map›Paper›PMID 31588983›Full record

SynthesisIntensive care medicine2020

Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials.

Fayez Alshamsi, Khalil Alshammari, Emilie Belley-Cote, Joanna Dionne, Talal Albrahim, Budoor Albudoor, Mona Ismail, Bandar Al-Judaibi, Bandar Baw, Ram M Subramanian and 8 more

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

54 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Liver support systems for adults with acute liver failure.The Cochrane database of systematic reviews · 2026
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Management of acute liver failure-an updated literature review.World journal of critical care medicine · 2025
    Review
  8. Review
  9. Observational
  10. Article
  11. Observational
  12. Acute and non-acute decompensation of liver cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Review
  13. Article
  14. Article
  15. Liver diseases: epidemiology, causes, trends and predictions.Signal transduction and targeted therapy · 2025
    Review
  16. Article
  17. Article
  18. Extracorporeal liver support techniques: a comparison.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2024
    Article
  19. Review
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Fayez AlshamsiDepartment of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates.
Khalil AlshammariDepartment of Internal Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia.
Emilie Belley-CoteDivision of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada.
Joanna DionneDivision of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada.
Talal AlbrahimDepartment of Anesthesiology and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Budoor AlbudoorDepartment of Critical Care Medicine, Shaikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Mona IsmailDivision of Gastroenterology, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia.
Bandar Al-JudaibiTransplant Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, USA, 14642.
Bandar BawDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada.
Ram M SubramanianDepartment of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Randolph SteadmanDepartment of Anesthesiology and Perioperative Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, USA.
Dragos GaluscaDepartment of Anesthesiology, Henry Ford Hospital, Detroit, MI, USA.
David T HuangDepartment of Critical Care Medicine, Director Multidisciplinary Acute Care Research Organization (MACRO), University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Rahul NanchalDepartment of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Mustafa Al QurainiDepartment of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.
Yuhong YuanDepartment of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada.
Waleed AlhazzaniDivision of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, L8S 4K1, Canada. alhazzaw@mcmaster.ca.ORCID http://orcid.org/0000-0001-8076-9626
GUIDE Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAcute liver failure (ALF) and acute on chronic liver failure (ACLF) are associated with significant mortality and morbidity. Extracorporeal liver support (ECLS) devices have been used as a bridge to liver transplant; however, the efficacy and safety of ECLS are unclear. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the efficacy and safety of ECLS in liver failure.

methodsWe searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception through March 13, 2019. RCTs comparing ECLS to usual care in ALF or ACLF were included. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence.

resultsWe identified 25 RCTs (1796 patients). ECLS use was associated with reduction in mortality (RR 0.84; 95% CI 0.74, 0.96, moderate certainty) and improvement in hepatic encephalopathy (HE) (RR 0.71; 95% CI 0.60, 0.84, low certainty) in patients with ALF or ACLF. The effect of ECLS on hypotension (RR 1.46; 95% CI 0.98, 2.2, low certainty), bleeding (RR 1.21; 95% CI 0.88, 1.66, moderate certainty), thrombocytopenia (RR 1.62; 95% CI 1.0, 2.64, very low certainty) and line infection (RR 1.92; 95% CI 0.11, 33.44, low certainty) was uncertain.

conclusionsECLS may reduce mortality and improve HE in patients with ALF and ACLF. The effect on other outcomes is uncertain. However, the evidence is limited by risk of bias and imprecision, and larger trials are needed to better determine the effect of ECLS on patient-important outcomes.

Indexed as

Extracorporeal CirculationHumansLiver FailureRandomized Controlled Trials as TopicAcute liver failureAcute on chronic liver failureAlbumin dialysisExchange transfusionExtracorporeal liver supportHemoperfusion

Identifiers

PMID31588983

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.