tetano
Editor, Senior Moderator
Crit Care
. 2022 May 23;26(1):147.
doi: 10.1186/s13054-022-04011-2.
Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis
Ryan Ruiyang Ling[SUP] #[/SUP][SUP] 1 [/SUP], Kollengode Ramanathan[SUP] #[/SUP][SUP] 2 3 [/SUP], Jackie Jia Lin Sim[SUP] 1 [/SUP], Suei Nee Wong[SUP] 4 [/SUP], Ying Chen[SUP] 5 [/SUP], Faizan Amin[SUP] 6 [/SUP], Shannon M Fernando[SUP] 7 [/SUP], Bram Rochwerg[SUP] 6 8 [/SUP], Eddy Fan[SUP] 9 [/SUP], Ryan P Barbaro[SUP] 10 11 [/SUP], Graeme MacLaren[SUP] 1 12 [/SUP], Kiran Shekar[SUP] #[/SUP][SUP] 13 14 15 [/SUP], Daniel Brodie[SUP] #[/SUP][SUP] 16 17 [/SUP]
Affiliations
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes.
Methods: We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology.
Results: Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8-52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run.
Conclusions: The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation.
Keywords: Coronavirus disease 2019; Extracorporeal membrane oxygenation; Meta-analysis; Mortality; Severe acute respiratory syndrome coronavirus 2.
. 2022 May 23;26(1):147.
doi: 10.1186/s13054-022-04011-2.
Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis
Ryan Ruiyang Ling[SUP] #[/SUP][SUP] 1 [/SUP], Kollengode Ramanathan[SUP] #[/SUP][SUP] 2 3 [/SUP], Jackie Jia Lin Sim[SUP] 1 [/SUP], Suei Nee Wong[SUP] 4 [/SUP], Ying Chen[SUP] 5 [/SUP], Faizan Amin[SUP] 6 [/SUP], Shannon M Fernando[SUP] 7 [/SUP], Bram Rochwerg[SUP] 6 8 [/SUP], Eddy Fan[SUP] 9 [/SUP], Ryan P Barbaro[SUP] 10 11 [/SUP], Graeme MacLaren[SUP] 1 12 [/SUP], Kiran Shekar[SUP] #[/SUP][SUP] 13 14 15 [/SUP], Daniel Brodie[SUP] #[/SUP][SUP] 16 17 [/SUP]
Affiliations
- PMID: 35606884
- DOI: 10.1186/s13054-022-04011-2
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes.
Methods: We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology.
Results: Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8-52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run.
Conclusions: The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation.
Keywords: Coronavirus disease 2019; Extracorporeal membrane oxygenation; Meta-analysis; Mortality; Severe acute respiratory syndrome coronavirus 2.
