Importance/Background: During current public health emergency of COVID-19 pandemic, repurposing of existing antiviral drugs may be an efficient strategy since there is no proven effective treatment. Published literature shows Remdesivir has broad-spectrum antiviral activity against numerous RNA viruses and has been recently recognized as a promising therapy against SARS-CoV-2.Methods: A systematic search was conducted for full length manuscripts published between inception and July 19th, 2020 focussing on efficacy and safety of Remdesivir in COVID-19. The primary outcomes were defined as mortality rate and median days to recovery based on the available pooled data. The secondary outcome was adverse events rate and drug discontinuation rate.Statistical Analysis: All outcomes were performed using Comprehensive Meta-Analysis software package (Bio stat, Englewood, NJ, USA).Results: A total of 1,895 patients from 9 studies were included in this qualitative synthesis. In patients treated with Remdesivir, the mean recovery time was 15.84 days (95% CI 11.68–20, SE 2.12; I2 = 97.24) and the pooled mortality rate was 11.3% (95% CI 7.9–16%; I2 = 74.85). However, treatment with Remdesivir was associated with adverse effects (55.3%, 95% CI 31.5–76.9%; I2 = 97.66) eventually warranting the discontinuation of the drug (17.8%, 95% CI 8.6–33.1%; I2 = 95.64). The meta-analysis of three clinical trials indicated that administration of Remdesivir significantly reduces the mortality compared to the placebo (OR 0.70, 95% CI 0.58–0.84, p ≤ 0.001; I2 = 16.6).Conclusions and Relevance: The result of contemporary meta-analysis suggests mortality benefit with Remdesivir in COVID-19 and median recovery time was over 2 weeks. The pooled mortality with Remdesivir was found to be very low, and this analysis can shed light on this potential treatment for COVID-19 patients.

A bstract Objectives This systematic review aims to provide insight into the outcome of extracorporeal membrane oxygenation (ECMO) and invasive mechanical ventilation use in critically ill COVID-19 patients. Data sources Electronic databases PubMed Central and PubMed were searched from January 2020 to June 2020 for published studies about ECMO and/or invasive mechanical ventilation use in COVID-19 patients. Data Extraction and Study Selection: The search strategy retrieved 766 articles, of which 19 studies consisting of 204 patients fulfilled the inclusion criteria and were included in the analysis. Data synthesis Primary outcomes evaluated were discharge and/or clinical improvement and mortality rate. Secondary outcomes evaluated included reported complications and the mean number of days of hospitalization for survivors. Weighted averages of included studies were calculated, and data were pooled in forest plots. Nearly, 68.1% of the patients received invasive mechanical ventilation without ECMO support, and 31.9% were placed on ECMO. Also, 22.5% of the patients were discharged and/or clinically improved and 51.5% died. Twenty-six percent of the study population deteriorated but remained alive or experienced no improvement in clinical condition. And 75.2% of those who died belonged to the non-ECMO group and 24.8% to the ECMO group. The mortality rate in the non-ECMO group was 56.8% compared to 40% in the ECMO group. Conclusion The utility of ECMO during a pandemic is uncertain as it is a resource-intensive modality, especially when the mortality rate in severely ill patients infected with COVID-19 virus is already known to be high. How to cite this article Nagraj S, Karia R, Hassanain S, Ghosh P, Shah VR, Thomas A. Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(6):691–698.

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Introduction: The gaps in geriatric care provision has become prominent with the onset of the coronavirus disease 2019 (COVID-19 pandemic). Despite the potential capability of the telehealth model to address the specific needs of geriatric patients, only a few geriatric guidelines have focused on the telehealth model during the pandemic. The following systematic review explores the current evidence of telehealth use and applications in geriatric care, which emerged post the COVID-19 pandemic. Methods: Three databases, including PubMed, Cochrane, and Google Scholar, were searched by three independent reviewers to identify relevant studies. Results: Seven studies were included in this review; two focused on the effectiveness of telehealth, three focused on the experiences of patients and providers, and two focused on the use of telehealth. Telehealth did not underperform compared to traditional care models in terms of self-efficacy, patient convenience, reduction in deferred care, increased efficiency of healthcare delivery, reduced travel issues, and improved health education. However, common challenges were disparities in access in favor of urban, cognitively sound, and younger geriatric patients. Conclusion: The current systematic review reported the latest evidence on telehealth use and access across geriatric care since the onset of the COVID-19 pandemic. Telemedicine is gaining support from literature for being non-inferior to traditional healthcare methods, as observed in our findings.