Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review

Abstract

Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) has gained popularity for the treatment of refractory respiratory failure during and after the 2009 influenza pandemic, and still represents a precious therapeutic resource for severe novel coronavirus 2019 infection. However, most of the published studies are small case series, and only two randomized trials exist in literature. Aim: Aim of this systematic review is to describe trends in VV ECMO treatment outcomes according to large studies only. Methods: We searched and included studies with more than 100 VV ECMO cases dated up to August 1st, 2019. Results: Thirty-three studies published in the period 2011–2019 met inclusion criteria, for a total of 12,860 patients (age 46.3 ± 17.4 years). ARDS was mainly by pneumonia, in 3126 (37%) cases; further 401(7%) patients had H1N1 Influenza A infection. Cannulation-related complications occurred in 502 (7%) cases. Weighted mean (95% confidence interval) of VV ECMO duration was 8.9 (8.7–9.1) days, and ICU stay was 23.6 (22.4–24.8) days. Mortality at the longest follow up available was 40%. Data collection in 70% of the studies had a duration of >5 years. Conclusion: This study reveals the characteristics of large case VV ECMO studies.

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

“…Veno-venous (V-V) ECMO is an invasive technique that oxygenates the blood and removes CO 2 while the failing lung is put at rest and is given time to recover. Management of ECMO patients is generally performed in tertiary care referral centers as it requires expertise in treatment of refractory respiratory failure and severe ARDS 1,2 .…”

Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions

“…Of note, several ECMO strategies may be used under the expertise typical of cardiac centers (venovenous or venoarterial; percutaneous or central cannulation), and this should be considered in relation to the clinical conditions, including the presence of RV dysfunction. However, these strategies expose patients to the risks of cannulation and systemic anticoagulation, 72 and the higher risk of bleeding and transfusions when systemic anticoagulation is started in the perioperative period of cardiac surgery should be considered.…”

Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology

“…73,74 Kim and colleagues aimed to analyze temporal trends, complications, and outcomes by performing a systematic review of a large population of VV-ECMO patients with ARDS. 75 The authors identified 33 studies and included 12 860 patients in their analysis. The average VV-ECMO patient was young (46.3 ± 17.4 years old), likely male (63% of patients), and most likely to have pneumonia as the cause of ARDS (37% undifferentiated pneumonia, 7% H1N1 pneumonia).…”