Extracorporeal membrane oxygenation for COVID-19 induced hypoxia: Single-center study

Alnababteh, Muhtadi; Hashmi, Muhammad Daniyal; Vedantam, Karthik; Chopra, Rajus; Kohli, Akshay; Hayat, Fatima; Kriner, Eric; Molina, Ezequiel; Pratt, Alexandra; Oweis, Emil; Zaaqoq, Akram

doi:10.1177/0267659120963885

Cited by 19 publications

(23 citation statements)

References 35 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12 cohorts contained comparative body mass index (BMI) data for COVID-19 survivors and nonsurvivors receiving ECMO support (Figure 2). 16,[18][19][20][23][24][25][26][27][28][29] The BMI was comparable among COVID-19 survivors and nonsurvivors requiring ECMO support (mean 30.07kg/m 2 vs 30.86kg/ m 2 , SMD 0.06; 95% CI [ − 0.23, 0.34]; I 2 = 43%; P = .70).…”

Section: Study Characteristicsmentioning

confidence: 94%

“…According to nine studies, the rate of bleeding complications was lower (32% vs 59%; OR 0.36; 95% CI 0.20-0.67;I 2 = 17%; P = .001) among COVID-19 survivors requiring ECMO support than nonsurvivors (Figure 5). [17][18][19][20][21][22]25,28,29 Five studies reported that COVID-19 survivors and nonsurvivors requiring ECMO support had comparable (43% vs 35%; OR 1.35; 95% CI 0.87-2.11;I 2 = 0%; P = .18) secondary infections rate (Figure 5). 18,20,25,28,29 Lastly, the rate of thromboembolism was similar (32% vs 30%; OR 1.89; 95% CI 0.55-6.47;I 2 = 77%; P = .31) between survivors and nonsurvivors of COVID-19 requiring ECMO support in four studies (Figure 5).…”

Section: Total Days On Mechanical Ventilation (Mv) Before Ecmo Support Initiation and Ecmo Durationmentioning

confidence: 99%

“…[16][17][18][19][20][21][22][23][24][28][29][30][31] In 13 cohorts, the total duration of ECMO support received by COVID-19 patients was similar (mean 15.39 vs 16.62 days; SMD − 0.07; 95% CI [ − 0.30, 0.15];I 2 = 15%; P = .51) between survivors and nonsurvivors (Figure 4). [17][18][19][20][21][22][23][24][25][26][28][29][30] Respiratory Parameters Within 24 h Before ECMO Support Initiation…”

Section: Total Days On Mechanical Ventilation (Mv) Before Ecmo Support Initiation and Ecmo Durationmentioning

confidence: 99%

See 2 more Smart Citations

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

Chong

Saha

Medarov

2021

J Intensive Care Med

View full text Add to dashboard Cite

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.

show abstract

Section: Study Characteristicsmentioning

confidence: 94%

Section: Total Days On Mechanical Ventilation (Mv) Before Ecmo Support Initiation and Ecmo Durationmentioning

confidence: 99%

Section: Total Days On Mechanical Ventilation (Mv) Before Ecmo Support Initiation and Ecmo Durationmentioning

confidence: 99%

See 1 more Smart Citation

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

Chong

Saha

Medarov

2021

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…1). [5,6,[12][13][14][15][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] After excluding 11 studies with overlapping information, we included twenty-two retrospective observational studies with 1896 patients in the meta-analysis. There were 20 single centre studies and two registry reports (Tables 1 and 2).…”

Section: Study Details and Demographicsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review and Meta-Analysis

Ramanathan

Shekar

Ling

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research.Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases from 1st December 2019 to 10th January 2021 for observational studies or randomized clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and metaregression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO.Results: We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI: 32.3%-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI: 30.7%-40.7%, high certainty). Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI: 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI:50.5%-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common.Conclusion: Majority of patients received ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1%, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS.PROSPERO CRD42020192627

show abstract

“…Refractory hypoxemia may develop, occasionally warranting the consideration of alternative strategies such as veno-venous extracorporeal membrane oxygenation (VV-ECMO). 1,2 Careful patient selection for VV-ECMO is a challenging task, as recently pointed out. 3 This raises important questions concerning the outcomes of patients who are not eligible for ECMO.…”

mentioning

confidence: 99%

Selecting candidates for veno-venous ECMO during COVID-19 pandemic: the importance of an ECMO team

et al. 2021

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation for COVID-19 induced hypoxia: Single-center study

Cited by 19 publications

References 35 publications

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

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

Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review and Meta-Analysis

Selecting candidates for veno-venous ECMO during COVID-19 pandemic: the importance of an ECMO team

Contact Info

Product

Resources

About