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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Mortality in patients with COVID-19 requiring extracorporeal membrane oxygenation: A meta-analysis
Ye Zhang1, Lei Wang1, Zhi-Xian Fang2
1Department of General Practice, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
Insights
Extracorporeal membrane oxygenation (ECMO) may be an effective treatment for COVID-19 patients, with an overall mortality rate of 31%. Further analysis is needed to optimize its use in critical care settings.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Cardiopulmonary Support
Background:
- Coronavirus disease 2019 (COVID-19) emerged as a global pandemic, posing significant public health challenges.
- The efficacy of extracorporeal membrane oxygenation (ECMO) for managing severe COVID-19 cases remains a critical question.
Purpose of the Study:
- To perform a meta-analysis evaluating the mortality rates of COVID-19 patients requiring ECMO support.
- To synthesize existing evidence on ECMO effectiveness in the context of the COVID-19 pandemic.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 guidelines, registered with PROSPERO (CRD42020227414).
- Quality assessment of included studies using the Newcastle-Ottawa Scale (NOS).
- Inclusion of studies with 10 or more COVID-19 patients undergoing ECMO; random-effects model for pooled mortality incidence.
Main Results:
- Analysis of 18 articles involving 1494 COVID-19 patients receiving ECMO; majority (93.7%) received veno-venous ECMO.
- Pooled overall mortality estimated at 31% (95% CI: 0.24-0.39), with significant heterogeneity (I² = 84.8%).
- Subgroup analyses revealed significant mortality variations by location, setting, sample size, and NOS scores, though heterogeneity sources were not definitively identified.
Conclusions:
- Extracorporeal membrane oxygenation (ECMO) demonstrates potential feasibility and effectiveness as a treatment for COVID-19 patients.
- Further research focusing on resource allocation and risk-benefit assessments is recommended to refine ECMO application strategies.
Background:
Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and significant public health issue. The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been called into question.
Aim:
To conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.
Methods:
This analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) and has been registered at the International Prospective Register of Systematic Reviews (number CRD42020227414). A quality assessment for all the included articles was performed by the Newcastle-Ottawa Scale (NOS). Studies with tenor more COVID-19 patients undergoing ECMO were included. The random-effects model was used to obtain the pooled incidence of mortality in COVID-19 patients receiving ECMO. The source of heterogeneity was investigated using subgroup and sensitivity analyses.
Results:
We identified 18 articles with 1494 COVID-19 patients who were receiving ECMO. The score of the quality assessment ranged from 5 to 8 on the NOS. The majority of patients received veno-venous ECMO (93.7%). Overall mortality was estimated to be 0.31 [95% confidence interval (CI): 0.24-0.39; I 2 = 84.8%] based on random-effect pooled estimates. There were significant differences in mortality between location groups (33.0% vs 55.0% vs 37.0% vs 18.0%, P < 0.001), setting groups (28.0% vs 34.0%, P < 0.001), sample size (37.0% vs 31.0%, P < 0.001), and NOS groups (39.0% vs 19.0%, P < 0.001). However, both subgroup analyses based on location, setting, and sample size, and sensitivity analysis failed to identify the source of heterogeneity. The funnel plot indicated no evident asymmetry, and the Egger's (P = 0.95) and Begg's (P = 0.14) tests also revealed no significant publication bias.
Conclusion:
With more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.
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