Extracorporeal Membrane Oxygenation Used in Acute Respiratory Distress Syndrome with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Introduction Protective pulmonary mechanical ventilation, higher positive end-expiratory pressure, neuromuscular blockade, prone positioning, and pulmonary recruitment procedures are all strategies in severe COVID-19 cases. Extracorporeal Membrane Oxygenation (ECMO) can be seen as an alternative to traditional treatment in certain patients when conventional therapy fails. We present a study that intends to systematically review and meta-analysis ECMO use in COVID-19 patients. Methods We search major medical databases (Cochrane Library, PubMed, EMBASE, MedRxiv) for clinical trials that were released between January 2020 until February 2021, had full-text availability, were written in English, and humans studies. We used National Heart, Lung, and Blood Institute (NHLBI) quality evaluation methods for retrospective cohort and cross-sectional studies to evaluate the quality of the articles. In addition, we used the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4. Results A total of 33 studies involving 3090 patients were included in the systematic review and six studies in the meta-analysis. There were 828 patients admitted to the ICU, of which 779 patients had ARDS (94%). Of the total study, 527 patients received ECMO therapy (17%). ARDS incidence was associated with complications during ICU care compared to non-ICU care (OR 107.98; 95% CI 55.51–210.03; p < 0.00001). Indirect comparisons, the incidence of mortality was associated with ECMO compared with non-ECMO (OR 15.79; 95% CI 4.21–59.28; p < 0.0001). Conclusion The incidence of ARDS was associated with complications during ICU stay, and the incidence of mortality was associated with ECMO. Further study about mechanisms involving illness and death of patients from COVID-19 is needed.

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

“…Previous meta-analyses have compared the effect of the presence or absence of ECMO use on COVID-19 mortality or the difference in mortality between COVID-19 and other virus-induced diseases treated with ECMO [7,77,[104][105][106]. For example, Kusumawardhani's study found a significantly higher incidence of mortality in COVID-19 patients treated with ECMO compared to those not treated with ECMO (OR = 15.79, 95% CI: 4.21-59.28, p < 0.0001) [106]. Ramanathan's meta-analysis reported an in-hospital ECMO mortality rate of 37.1% for COVID-19 patients, which is similar to that of patients with non-COVID-19-related ARDS [7].…”

Hyperoxia in the management of respiratory failure: A literature review

“…In normal humans, initial toxic effects appear after 10 h of 1 ATA oxygen exposure. The clinical picture is divided into three phases, namely: (a) tracheobronchitis, (b) ARDS, and (c) pulmonary interstitial fibrosis [ 18 , 20 , 33 ]. Oxygen can be tolerated above sea level for about 24–48 h without severe tissue damage.…”