Mortality in Patients with COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Meta-analysis

Background: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and significant public health issue. The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been called into question.

Aim: To conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.

Methods: This analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) and has been registered at the International Prospective Register of Systematic Reviews (number CRD42020227414). A quality assessment for all the included articles was performed by the Newcastle-Ottawa Scale (NOS). Studies with tenor more COVID-19 patients undergoing ECMO were included. The random-effects model was used to obtain the pooled incidence of mortality in COVID-19 patients receiving ECMO. The source of heterogeneity was investigated using subgroup and sensitivity analyses.

Results: We identified 18 articles with 1494 COVID-19 patients who were receiving ECMO. The score of the quality assessment ranged from 5 to 8 on the NOS. The majority of patients received veno-venous ECMO (93.7%). Overall mortality was estimated to be 0.31 [95% confidence interval (CI): 0.24-0.39; = 84.8%] based on random-effect pooled estimates. There were significant differences in mortality between location groups (33.0% 55.0% 37.0% 18.0%, < 0.001), setting groups (28.0% 34.0%, < 0.001), sample size (37.0% 31.0%, < 0.001), and NOS groups (39.0% 19.0%, < 0.001). However, both subgroup analyses based on location, setting, and sample size, and sensitivity analysis failed to identify the source of heterogeneity. The funnel plot indicated no evident asymmetry, and the Egger's ( = 0.95) and Begg's ( = 0.14) tests also revealed no significant publication bias.

Conclusion: With more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.