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

Bertini, Pietro; Guarracino, Fabio; Falcone, Marco; Nardelli, Pasquale; Landoni, Giovanni; Nocci, Matteo; Paternoster, Gianluca

doi:10.1053/j.jvca.2021.11.006

Cited by 73 publications

(76 citation statements)

References 42 publications

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“…First, this meta-analysis of more than 18,000 patients summarises the largest and most comprehensive cohort of patients requiring ECMO for COVID-19 to date. While previous reviews were limited by the number of studies [ 80 ], our analysis is with a larger sample size, allows for more precision in the pooled estimate, and allows us to more clearly elicit factors that are associated with mortality. In addition to being concordant with previous studies [ 3 , 5 ], our study provides confirmation of the increase in mortality from a much larger sample size and from multiple studies throughout the world.…”

Section: Discussionmentioning

confidence: 99%

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

et al. 2022

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Background Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes. Methods We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology. Results Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8–52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run. Conclusions The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation.

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Section: Discussionmentioning

confidence: 99%

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

et al. 2022

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“…According to the ELSO COVID-19 Dashboard, in-hospital mortality is 47% [ 122 ]. This is slightly higher than a systematic review and meta-analysis of 4044 COVID-19 patients receiving ECMO, which found in-hospital mortality was 39% [ 123 ]. Early in the pandemic, it appeared that the duration of ECMO was longer for patients with COVID-19 and mortality rates were similar, but this trend appears to be changing as studies continue to be published [ 121 ].…”

Section: Discussionmentioning

confidence: 77%

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

Chavez

Brady

Gottlieb

et al. 2022

The American Journal of Emergency Medicine

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“…Given the acute respiratory distress syndrome (ARDS) as a prominent feature of COVID-19, the role of veno-venous (V-V) ECMO support is evolving ( 36 ). The challenging question is if the benefits of VA-ECMO could outweigh the risks of adverse events to recommend placing VA-ECMO bypass in COVID patients?…”

Section: Discussionmentioning

confidence: 99%

“…The challenging question is if the benefits of VA-ECMO could outweigh the risks of adverse events to recommend placing VA-ECMO bypass in COVID patients? In adults, the highest-priority VA-ECMO for cardiogenic shock-related SARS-CoV-2 is based on an individual basis and with a multidisciplinary team approach, including the young, the critically ill, and those with the greatest perceived benefit and fewest or no comorbidities, as well as healthcare workers ( 36 ). Currently, published extracorporeal life support organization (ELSO) guidelines recommend instituting V-A support for cardiac compromise associated with COVID-19-induced myocarditis and MIS-C, applying standard pediatric institutional ECMO protocols ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Successful Treatment of a Child With COVID-19 Reinfection-Induced Fulminant Myocarditis by Cytokine-Adsorbing oXiris® Hemofilter Continuous Veno-Venous Hemofiltration and Extracorporeal Membrane Oxygenation

et al. 2022

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BackgroundIndirect cardiomyocyte damage-related hyperinflammatory response is one of the key mechanisms in COVID-19-induced fulminant myocarditis. In addition to the clinical benefit of using cytokines absorption hemofiltration, the effectiveness of instituting veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiac compromise has been reported. However, current literature enunciates a paucity of available data on the effectiveness of these novel modalities.Case PresentationWe reported a 9-year-old boy with recurrent COVID-19 infection-causing fulminant myocarditis, who was treated successfully by using novel modalities of oXiris® hemofilter continuous venovenous hemofiltration (CVVH) and VA-ECMO. The patient made a full recovery without any sequelae.ConclusionWe conclude that the novel highly-absorptive hemofilter CVVH and VA-ECMO may be effective treatment modalities in managing SARS-CoV-2-induced fulminant myocarditis. Our report highlights the need for further well-designed investigations to confirm this extrapolation.

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

Cited by 73 publications

References 42 publications

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

Case Report: Successful Treatment of a Child With COVID-19 Reinfection-Induced Fulminant Myocarditis by Cytokine-Adsorbing oXiris® Hemofilter Continuous Veno-Venous Hemofiltration and Extracorporeal Membrane Oxygenation

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