Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review

Abstract

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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“…Another recent study shows a 40% mortality in COVID 19 and ECMO patients. Age, multiple comorbidities, lower pre-ECMO pH, renal replacement techniques, requirement of vasoactive drugs and bleeding were predictors of death in these patients [68][69][70][71].…”

Is Extracorporeal Membrane Oxygenation a Panacea?

“… 97 The utility of ECMO should be evaluated based on current circumstances, considering the need for specialized patient care and the capacity to manage a high volume of patients through centralization. 98 …”

ACE2 gene expression and inflammatory conditions in periodontal microenvironment of COVID-19 patients with and without diabetes evaluated by qPCR

“…From a dental perspective, the outbreak of the COVID-19 pandemic poses a threat to the practice of dentistry. This is because the oral cavity should be considered a preferential route for the entry or transmission of the related-virus (SARS-CoV-2) among populations that can occur directly or indirectly [1-3], particularly in nosocomial environments at risk [4]. Recent studies have shown that COVID-19 infection and severity can be linked to the presence of periodontitis [5].…”

“…particularly in nosocomial environments at risk [4]. Recent studies have shown that COVID-19 infection and severity can be linked to the presence of periodontitis [5].…”