ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis

Overview

Journal J Cardiothorac Vasc Anesth

Specialties Anesthesiology
Cardiology & Vascular Diseases
Pulmonary Medicine

Date 2021 Dec 15

PMID 34906383

Citations 40

Authors

Pietro Bertini

Fabio Guarracino

Marco Falcone

Pasquale Nardelli

Giovanni Landoni

Matteo Nocci

Gianluca Paternoster

Affiliations

Soon will be listed here.

Abstract

Objective: To analyze the survival rates of patients with COVID-19 supported with extracorporeal membrane oxygenation (ECMO) and compare the survival rates of patients with COVID-19 supported with ECMO to patients with influenza supported with ECMO.

Design: A systematic review and meta-analysis to assess the impact of ECMO as supportive therapy of COVID-19.

Setting: The authors performed a search through the Cochrane, EMBASE, and MEDLINE/PubMed databases from inception to February 19, 2021, for studies reporting hospitalized patients with COVID-19 managed with ECMO.

Participants: A total of 134 studies were selected, including 6 eligible for the comparative meta-analysis of COVID-19 versus influenza.

Interventions: The authors pooled the risk ratio and random effects model.

Measurements And Main Results: The primary endpoint was the overall mortality of patients with COVID-19 receiving ECMO. Of the total number of 58,472 patients with COVID-19 reported, ECMO was used in 4,044 patients. The analysis suggested an overall in-hospital mortality of 39% (95% CI 0.34-0.43). In the comparative analysis, patients with COVID-19 on ECMO had a higher risk ratio (RR) for mortality when compared to influenza patients on ECMO: 72/164 (44%) v 71/186 (38%) RR 1.34; 95% CI 1.05-1.71; p = 0.03.

Conclusions: ECMO could be beneficial in patients with COVID-19, according to the authors' meta-analysis. The reported mortality rate was 39%. This systematic analysis can provide clinical advice in the current era and ongoing pandemic.

Citing Articles

Resolution of Acute Respiratory Distress Syndrome-Induced Takotsubo Cardiomyopathy with Venovenous Extracorporeal Membrane Oxygenation.

Wadiwala I, Garg P, Allen W, Pham S, Thomas M Braz J Cardiovasc Surg. 2024; e20230117(e20230117).

PMID: 39418591 PMC: 11497616. DOI: 10.21470/1678-9741-2023-0117.

Platelet Aggregation Alterations in Patients with Severe Viral Infection Treated at the Intensive Care Unit: Implications for Mortality Risk.

Bakowski W, Smiechowicz J, Dragan B, Gozdzik W, Adamik B Pathogens. 2024; 13(9).

PMID: 39338970 PMC: 11435101. DOI: 10.3390/pathogens13090778.

Outcomes and Impact of Pre-ECMO Clinical Course in Severe COVID-19-Related ARDS Treated with VV-ECMO: Data from an Italian Referral ECMO Center.

Sales G, Montrucchio G, Sanna V, Collino F, Fanelli V, Filippini C J Clin Med. 2024; 13(12).

PMID: 38930073 PMC: 11204940. DOI: 10.3390/jcm13123545.

Status of COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation in Japan: Nationwide Database Analysis.

Kuribara T, Asai Y, Ohmagari N, Yokota I Cureus. 2024; 16(5):e60202.

PMID: 38868250 PMC: 11168340. DOI: 10.7759/cureus.60202.

Population Pharmacokinetic Model of Linezolid and Probability of Target Attainment in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation-A Step toward Correct Dosing.

Milakovic D, Kovacevic T, Kovacevic P, Barisic V, Avram S, Dragic S Pharmaceutics. 2024; 16(2).

PMID: 38399307 PMC: 10892643. DOI: 10.3390/pharmaceutics16020253.

References

Piroth L, Cottenet J, Mariet A, Bonniaud P, Blot M, Tubert-Bitter P . Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. Lancet Respir Med. 2020; 9(3):251-259. PMC: 7832247. DOI: 10.1016/S2213-2600(20)30527-0. View

Brodie D, Slutsky A, Combes A . Extracorporeal Life Support for Adults With Respiratory Failure and Related Indications: A Review. JAMA. 2019; 322(6):557-568. DOI: 10.1001/jama.2019.9302. View

Donnino M, Moskowitz A, Thompson G, Heydrick S, Pawar R, Berg K . Comparison between Patients Hospitalized with Influenza and COVID-19 at a Tertiary Care Center. J Gen Intern Med. 2021; 36(6):1689-1695. PMC: 7971402. DOI: 10.1007/s11606-021-06647-2. View

Rajagopal K, Keller S, Akkanti B, Bime C, Loyalka P, Cheema F . Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIOa Living Working Document. Circ Heart Fail. 2020; 13(5):e007175. PMC: 7304497. DOI: 10.1161/CIRCHEARTFAILURE.120.007175. View

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

Zangrillo A, Biondi-Zoccai G, Landoni G, Frati G, Patroniti N, Pesenti A . Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO. Crit Care. 2013; 17(1):R30. PMC: 4057025. DOI: 10.1186/cc12512. View

Murad M, Sultan S, Haffar S, Bazerbachi F . Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018; 23(2):60-63. PMC: 6234235. DOI: 10.1136/bmjebm-2017-110853. View

Gjurasin B, Santini M, Krajinovic V, Papic N, Atelj A, Kotarski V . A retrospective comparison between influenza and COVID-19-associated ARDS in a Croatian tertiary care center. Wien Klin Wochenschr. 2020; 133(7-8):406-411. PMC: 7677748. DOI: 10.1007/s00508-020-01759-x. View

Sharma G, Volgman A, Michos E . Sex Differences in Mortality From COVID-19 Pandemic: Are Men Vulnerable and Women Protected?. JACC Case Rep. 2020; 2(9):1407-1410. PMC: 7198137. DOI: 10.1016/j.jaccas.2020.04.027. View

10.

Charlton M, Dashey S, Stubbs A, Lai F, Bird P, Badhwar V . Comparing SARS-CoV-2 and influenza A(H1N1)pdm09-infected patients requiring ECMO - A single-centre, retrospective observational cohort experience. J Infect. 2020; 82(4):84-123. PMC: 7649630. DOI: 10.1016/j.jinf.2020.11.003. View

11.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S . Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020; 180(7):934-943. PMC: 7070509. DOI: 10.1001/jamainternmed.2020.0994. View

12.

Barendregt J, Doi S, Lee Y, Norman R, Vos T . Meta-analysis of prevalence. J Epidemiol Community Health. 2013; 67(11):974-8. DOI: 10.1136/jech-2013-203104. View

13.

Badulak J, Antonini M, Stead C, Shekerdemian L, Raman L, Paden M . Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J. 2021; 67(5):485-495. PMC: 8078022. DOI: 10.1097/MAT.0000000000001422. View

14.

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

15.

Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N . Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009; 302(17):1888-95. DOI: 10.1001/jama.2009.1535. View

16.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

17.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7):e1000100. PMC: 2707010. DOI: 10.1371/journal.pmed.1000100. View

18.

Raff L, Reid T, Johnson D, Raff E, Schneider A, Charles A . Comparative outcomes between COVID-19 and influenza patients placed on veno-venous extracorporeal membrane oxygenation for severe ARDS. Am J Surg. 2021; 223(2):388-394. PMC: 8056852. DOI: 10.1016/j.amjsurg.2021.04.004. View

19.

Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G . A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013; 15(3):172-8. View

20.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-1062. PMC: 7270627. DOI: 10.1016/S0140-6736(20)30566-3. View