Specific Considerations for Venovenous Extracorporeal Membrane Oxygenation During Coronavirus Disease 2019 Pandemic

Guihaire, Julien; Owyang, Clark; Madhok, Jai; Laverdure, Florent; Gaillard, Maïra; Girault, Antoine; Lebreton, Guillaume; Mercier, Olaf

doi:10.1097/mat.0000000000001251

Cited by 13 publications

(16 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Appraisal using the JBI checklist for cohort studies and case series suggested a high level of quality across the included studies for this review. All studies, except two [ 13 , 32 ], had scores above 8/10 (Additional file 1 : Table S2). A summary of the GRADE assessment for certainty of evidence is provided in Additional file 1 : Table S4.…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

et al. 2021

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 1 December 2019 to 10 January 2021 for observational studies or randomised clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and meta-regression, 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). Meta-regression found that age and ECMO duration were associated with increased mortality. 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 The majority of patients received venovenous ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1% during the first year of the pandemic, 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

Section: Resultsmentioning

confidence: 99%

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In a monocentric observation study, 17% of COVID-19 patients with ECMO support developed pulmonary hemorrhage that required intervention. Three cases were successfully controlled by temporary disruption of heparin for few days, and in one case successful embolization of a pulmonary artery was performed [ 1 ]. Murgo et al.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary hemorrhage is a recurring finding in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and has been reported in 17% of cases with severe coronavirus disease 2019 (COVID-19) on extracorporeal support [ 1 ]. Necrotizing pneumonia is strongly associated with the occurrence of pulmonary hemorrhage and severely elevated inflammatory markers and comes with a poor prognosis [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous massive hemothorax as a complication of necrotizing pneumonia in a patient with severe acute respiratory syndrome coronavirus 2 induced acute respiratory distress syndrome: a case report

et al. 2021

View full text Add to dashboard Cite

Background We present an unusual bleeding complication in a patient with severe acute respiratory distress syndrome in coronavirus disease 2019. Case presentation The patient, a 63-year-old Caucasian man, received venovenous extracorporeal membrane oxygenation support after rapid deterioration of lung function on day 6 after admission to hospital. After initial stabilization on lung protective ventilation and prone positioning, he started to develop mild bleeding complications until he went into occult profound hemorrhagic shock. Causative was a massive hemothorax of the right hemithorax with mediastinal shifting due to spontaneous bleeding from a pulmonal artery in a heavily remodeled right inferior lobe. Histopathological examination of the resected tissue showed signs of an organizing fibrinous pneumonia with focal parenchyma necrosis. After surviving a massive bleeding event caused by necrotizing pneumonia, the patient made a swift recovery and was discharged to rehabilitation 31 days after initial hospital admission. Conclusions The combination of severely elevated inflammatory markers and pulmonary hemorrhage should arouse suspicion of necrotizing pneumonia. In necrotizing pneumonia, the possibility of severe intrathoracic bleeding complications should be kept in mind if it comes to sudden deterioration of the patient.

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%

“…Appraisal using the JBI checklist for cohort studies and case series suggested a high level of quality across the included studies for this review. All studies, except two, [13,32] had scores above 8/10 (Supplementary Table 3). A summary of the GRADE assessment for certainty of evidence is provided in Supplementary Table 4.…”

Section: Assessment Of Study Qualitymentioning

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

Specific Considerations for Venovenous Extracorporeal Membrane Oxygenation During Coronavirus Disease 2019 Pandemic

Cited by 13 publications

References 7 publications

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

Spontaneous massive hemothorax as a complication of necrotizing pneumonia in a patient with severe acute respiratory syndrome coronavirus 2 induced acute respiratory distress syndrome: a case report

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

Contact Info

Product

Resources

About