Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

Abstract

Background: The use of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19) for refractory respiratory failure, severe cardiac dysfunction, and bridge to lung transplantation has been steadily increasing during the ongoing global pandemic. Objective: Our meta-analysis aims to compare the clinical characteristics between COVID-19 survivors and nonsurvivors requiring ECMO support. Methods: A systematic search of Pubmed, Cochrane, Embase, Scopus, and Web of Science databases was performed between December first, 2019, to June first, 2021. Studies with comparative data of COVID-19 ECMO patients were selected, in which clinical characteristics and complications were assessed. Results: Sixteen cohort studies involving 706 COVID-19 patients requiring ECMO support with pooled mortality rate of 40% were included. Younger age (mean 51 years vs 55 years; P < .001), fewer comorbidities (23% vs 31%; odds ratio [OR] 0.55; P = .02), and less renal replacement therapy (RRT) (21% vs 39%; OR 0.41; P = .007) and vasopressor (76% vs 92%; OR 0.35; P = .008) requirement were demonstrated in COVID-19 survivors requiring ECMO support than nonsurvivors. Survivors also had higher pre-ECMO pH (mean 7.33 vs 7.26; P < .001) than nonsurvivors. No difference was observed in gender, body mass index, duration of mechanical ventilation (MV) before ECMO support initiation, total ECMO support duration, and pre-ECMO parameters of PaO2/FiO2 ratio, tidal volume (mL/kg), positive end-expiratory pressure, and plateau pressure. The rate of bleeding complications was lower in survivors (32% vs 59%; OR 0.36; P = .001) than nonsurvivors, but no difference was observed in thromboembolism and secondary infections. Conclusions: We found advanced age, multiple comorbidities, lower pre-ECMO pH, greater RRT, and vasopressor requirements, and bleeding are predictors of death in COVID-19 patients requiring ECMO support. The duration of MV before ECMO support initiation and total ECMO support duration was similar among survivors and nonsurvivors. Our study results have important clinical implications when considering ECMO support in critically ill COVID-19 patients.

COVID-19 outcomes of venovenous extracorporeal membrane oxygenation for acute respiratory failure vs historical cohort of non-COVID-19 viral infections

“…Current literature is mixed in comparison of COVID-19 and non-COVID-19 viral illness supported with VV ECMO in regards to survival, pre-cannulation factors, and hospital course. 12 – 14 …”

Clinical Outcomes of Early Versus Late Tracheostomy in Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis

“…1) Critically ill COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) frequently require prolonged IMV, and tracheostomy is often performed early to improve patient comfort and reduce sedation. 38,56 Only one study described the proportion of COVID-19 patients undergoing early versus late tracheostomy while on ECMO. 25 In the other studies, no comparative data were available for those undergoing early versus late tracheostomy, and whether ECMO was initiated before or after tracheostomy was not analyzed.…”

Clinical Outcomes of Routine Awake Prone Positioning in COVID-19 Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Other important clinical outcomes such as mortality, IMV requirement, ICU and hospital LOS, and adverse events were assessed because APP might provide a false sense of reassurance leading to potentially delayed escalation of respiratory support and IMV initiation. We also included RCTs from the grey literature of medRxiv to reduce publication bias and used mortality from the longest follow-up period to avoid missing important data contributed by the delayed clinical decompensation from the atypical COVID-19 phenotype (Chong et al, 2021(Chong et al, , 2022. The prolonged duration of patient enrolment as the RCTs were conducted between April 2020 and May 2021 would increase the generalizability due to the rapid advancement in COVID-19 therapies and the increase in APP experience gained among healthcare providers from previous waves of the ongoing pandemic.…”