Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review

COVID-19 may result in acute respiratory distress (ARDS) in patients with the severe form of the disease. Extracorporeal membrane oxygenation (ECMO) can support respiratory gas interchange in patients failing conventional methods, but its effectiveness in COVID patients is still debatable. The aim of this study is to find the survival outcomes of patients with and without COVID-19 ARDS who were supported with extracorporeal membrane oxygenation (ECMO). PubMed, Medline, and Google Scholar databases were searched from 2020 to 2022. Studies comparing the outcomes of ECMO in COVID and non-COVID ARDS were included. The outcomes that were measured were mortality or survival, survival to discharge, ECMO duration, and complications. This systematic review encompassed 12 retrospective observational studies and one quasi-controlled trial, including a total of 12 studies that recruited 1,133 patients (495 COVID-19 and 638 non-COVID ARDS patients) and were published between 2020 and 2022. The overall mortality rate of ECMO-supported COVID-19 patients was 41% and ranged between 14.7% and 67%. On the other hand, non-COVID ARDS patients' mortality rate ranges from 14.3% to 50%. In comparison, COVID-19 patients had a prolonged duration of ECMO therapy as well as increased bleeding and thrombotic complications. Our findings suggest that ECMO remains a viable option for the management of COVID-19-associated acute respiratory distress syndrome for selected patients. The observed mortality rate was 41%. Meta-analyses are warranted to obtain more conclusive results and assess the risk.