INFECTIOUS DISEASES / SYSTEMATIC REVIEW/META-ANALYSIS
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The COVID-19 pandemic represents a major worldwide challenge, with a great impact on health systems and economic mechanisms. SARS-CoV-2, the pathogenic agent that generates COVID-19, creates a wide variety of organ dysfunctions, from acute respiratory distress syndrome (ARDS) to acute myocardial infarction or pulmonary embolism. Mechanical circulatory support devices such as extracorporeal membrane circulatory oxygenation (ECMO) have shown their efficacy in maintaining organ perfusion in respiratory and cardiac impairments. With this review, we aimed to assess the impact of ECMO use in COVID-19 patients with ARDS.

Material and methods:
We performed a systematic review to find studies using ECMO in COVID-19. Comorbidities, side effects, and survival rate to discharge were analysed. The literature search was done using PubMed/MEDLINE, Web of Science, Embase (Elsevier), the Cochrane Central Register of Controlled Trials (Wiley) and clinicaltrials.gov databases (inception (December 2019) to October 16, 2021), by 2 authors.

Results:
We included 33 studies from 10 countries with a total of 4760 patients receiving ECMO for COVID-19. The survival rate varied from 9% to 90.6% at discharge. The most serious adverse events were acute kidney injury (up to 87%), major bleeding (up to 92.1%), strokes or cerebral haemorrhage (up to 34%). Other complications such as pulmonary embolism, peripheral bleeding, or sepsis had a major impact on survival rates.

Conclusions:
ECMO in COVID-19 patients may be a useful rescue therapy instrument, but due to the great variability of studies and still unknown mechanisms and effects of SARS-CoV-2, further studies need to be done.
REFERENCES (68)
1.
Matthay MA, Zemans RL, Zimmerman GA, et al. Acute respiratory distress syndrome. Nat Rev Dis Primers 2019; 5: 18.
 
2.
Auld S, Caridi-Scheible M, Blum JM, et al. ICU and ventilator mortality among critically ill adults with COVID-19. medRxiv 2020; 2020.04.23.20076737.
 
3.
Sen A, Callisen HE, Alwardt CM, et al. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: current status and future perspectives. Ann Card Anaesth 2016; 19: 97-111.
 
4.
Chen C, Zhou Y, Wang DW. SARS-CoV-2: a potential novel etiology of fulminant myocarditis. Herz 2020; 45: 230-2.
 
5.
Extracorporeal Life Support Organization (2015) ECLS Registry Report. https://www.elso.org/Registry/.... Accessed 3 September 2020.
 
6.
Lindskov C, Jensen RH, Sprogoe P, et al. Extracorporeal membrane oxygenation in adult patients with severe acute respiratory failure. Acta Anesthesiol Scand 2013; 57: 303-11.
 
7.
Zavalichi MA, Nistor I, Nedelcu AE, et al. Extracorporeal membrane oxygenation in cardiogenic shock due to acute myocardial infarction: a systematic review. Biomed Res Int 2020; 2020: 6126534.
 
8.
Shekar K, Badulak J, Peek G, et al. Extracorporeal Life Support Organization COVID-19 Interim Guidelines. ASAIO J 2020; 66: 707-21.
 
9.
Vaquer S, de Haro C, Peruga P, et al. Sytematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care 2017; 7: 51.
 
10.
Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 2011; 365: 1905-14.
 
11.
Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A (H1N1). JAMA 2011; 306: 1659-68.
 
12.
Pham T, Combes A, Rozé H, et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome a cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2013; 187: 276-85.
 
13.
Patroniti N, Zangrillo A, Pappalardo F, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med 2011; 37: 1447-57.
 
14.
Holzgraefe B, Broomé M, Kalzén H, et al. Extracorporeal membrane oxygenation for pandemic H1N1 2009 respiratory failure. Minerva Anestesiol 2010; 76: 1043-51.
 
15.
Bartlett RH, Ogino MT, Brodie D, et al. Initial ELSO Guidance Document: ECMO for COVID-19 patients with severe cardiopulmonary failure. ASAIO J 2020; 66: 472-4.
 
16.
Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018; 378: 1965-75.
 
17.
Crichton ML, Goeminne PC, Tuand K, et al.; European Respiratory Society COVID-19 Task Force. The impact of therapeutics on mortality in hospitalised patients with COVID-19: systematic review and meta-analyses informing the European Respiratory Society living guideline. Eur Respir Rev 2021; 30: 210171.
 
18.
Zuñiga RAA, Coca SM, Abeldaño GF, González-Villoria RAM. Clinical effectiveness of drugs in hospitalized patients with COVID-19: a systematic review and meta-analysis. Ther Adv Respir Dis 2021; 15: 17534666211007214.
 
19.
Qomara WF, Primanissa DN, Amalia SH, Purwadi FV, Zakiyah N. Effectiveness of remdesivir, lopinavir/ritonavir, and favipiravir for COVID-19 treatment: a systematic review. Int J Gen Med 2021; 14: 8557-71.
 
20.
Vandenbrande J, Verbrugge L, Bruckers L, et al. Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV score in COVID-19 patients. Crit Care Res Pract 2021; 2021: 5443083.
 
21.
Wikipedia contributors. (2022, January 18). APACHE II. In Wikipedia, The Free Encyclopedia. Retrieved 17:10, March 2, 2022, from https://en.wikipedia.org/w/ind... title=APACHE_II&oldid=1066469136.
 
22.
Patel AR, Patel AR, Singh S, et al. Venovenous extracorporeal membrane oxygenation therapy in adults. Cureus 2019; 11: e5365.
 
23.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration BMJ 2009; 339: b2700.
 
24.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta analyses. Eur J Epidemiol 2010; 25: 603-5.
 
25.
Tabatabai A, Ghneim MH, Kaczorowski DJ, et al. Mortality risk assessment in COVID-19 venovenous extracorporeal membrane oxygenation. Ann Thorac Surg 2021; 112: 1983-9.
 
26.
Yang X, Hu M, Yu Y, et al. Extracorporeal membrane oxygenation for SARS-CoV-2 acute respiratory distress syndrome: a retrospective study from Hubei, China. Front Med 2021; 7: 611460.
 
27.
Raasveld SJ, Delnoij TSR, Broman LM, et al.; ETALON Study Group, Vlaar APJ. Extracorporeal membrane oxygenation in patients with COVID-19: an international multicenter cohort study. J Intensive Care Med 2021; 36: 910-7.
 
28.
Nguyen NT, Sullivan B, Sagebin F, Hohmann SF, Amin A, Nahmias J. Analysis of COVID-19 patients with acute respiratory distress syndrome managed with extracorporeal membrane oxygenation at US Academic Centers. Ann Surg 2021; 274: 40-4.
 
29.
Shih E, Squiers JJ, DiMaio JM, et al. Outcomes of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome caused by COVID-19 versus influenza. Ann Thorac Surg 2022; 113: 1445-51.
 
30.
Fang J, Li R, Chen Y, et al. Extracorporeal membrane oxygenation therapy for critically ill coronavirus disease 2019 patients in Wuhan, China: a retrospective multicenter cohort study. Curr Med Sci 2021; 41: 1-13.
 
31.
Garfield B, Bianchi P, Arachchillage D, et al. Six month mortality in patients with COVID-19 and non-COVID-19 viral pneumonitis managed with veno-venous extracorporeal membrane oxygenation. ASAIO J 2021; 67: 982-8.
 
32.
Weir-McCall JR, Galea G, Mun Mak S, et al. Vascular thrombosis in severe coronavirus disease 2019 requiring extracorporeal membrane oxygenation: a multicenter study. Crit Care Med 2022; 50: 624-32.
 
33.
Bissell BD, Gabbard T, Sheridan EA, Baz MA, Davis GA, Ather A. Evaluation of bivalirudin as the primary anticoagulant in patients receiving extracorporeal membrane oxygenation for SARS-CoV-2-associated acute respiratory failure. Ann Pharmacother 2022; 56: 387-92.
 
34.
Supady A, DellaVolpe J, Taccone FS, et al. Outcome prediction in patients with severe COVID-19 requiring extracorporeal membrane oxygenation-a retrospective international multicenter study. Membranes 2021; 11: 170.
 
35.
Doyle AJ, Hunt BJ, Sanderson B, et al. A comparison of thrombosis and hemorrhage rates in patients with severe respiratory failure due to coronavirus disease 2019 and influenza requiring extracorporeal membrane oxygenation. Crit Care Med 2021; 49: e663-72.
 
36.
Schmidt M, Langouet E, Hajage D, et al.; GRC RESPIRE Sorbonne Université. Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris. Crit Care 2021; 25: 355.
 
37.
Arachchillage DJ, Rajakaruna I, Scott I, et al. Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study. Br J Haematol 2022; 196: 566-76.
 
38.
Saeed O, Tatooles AJ, Farooq M, et al.; COVID-19 ECMO Working Group. Characteristics and outcomes of patients with COVID-19 supported by extracorporeal membrane oxygenation: a retrospective multicenter study. J Thorac Cardiovasc Surg 2022: 163: 2107-116.e6.
 
39.
Onorati F, Myers P, Bajona P, Perrotti A, Mestres CA, Quintana E. Effects of COVID-19 pandemic on cardiac surgery practice in 61 hospitals worldwide: results of a survey. J Cardiovasc Surg 2020; 61: 763-8.
 
40.
Loforte A, Di Mauro M, Pellegrini C, et al.; endorsed by the Italian Society for Cardiac Surgery (SICCH). Extracorporeal membrane oxygenation for COVID-19 respiratory distress syndrome: an Italian Society for Cardiac Surgery Report. ASAIO J 2021; 67: 385-91.
 
41.
Bergman ZR, Wothe JK, Alwan FS, et al. Risk factors of mortality for patients receiving venovenous extracorporeal membrane oxygenation for COVID-19 acute respiratory distress syndrome. Surg Infect 2021; 22: 1086-92.
 
42.
Li X, Hu M, Zheng R, et al. Delayed initiation of ECMO is associated with poor outcomes in patients with severe COVID-19: a multicenter retrospective cohort study. Front Med 2021; 8: 716086.
 
43.
Biancari F, Mariscalco G, Dalén M, et al. Six-month survival after extracorporeal membrane oxygenation for severe COVID-19. J Cardiothorac Vasc Anesth 2021; 35: 1999-2006.
 
44.
Mustafa AK, Joshi DJ, Alexander PJ, et al. Comparative propensity matched outcomes in severe COVID-19 respiratory failure-extracorporeal membrane oxygenation or maximum ventilation alone. Ann Surg 2021; 274: e388-94.
 
45.
Ogura T, Ohshimo S, Liu K, Iwashita Y, Hashimoto S, Takeda S. Establishment of a disaster management-like system for COVID-19 patients requiring veno-venous extracorporeal membrane oxygenation in Japan. Membranes 2021; 11: 625.
 
46.
Cho SM, Premraj L, Fanning J, et al. Ischemic and hemorrhagic stroke among critically ill patients with coronavirus disease 2019: an International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study. Crit Care Med 2021; 49: e1223-33.
 
47.
Zaaqoq AM, Barnett AG, Griffee MJ, et al.; COVID-19 Critical Care Consortium (COVID Critical). Beneficial effect of prone positioning during venovenous extracorporeal membrane oxygenation for coronavirus disease 2019. Crit Care Med 2022; 50: 275-85.
 
48.
Suwalski P, Drobiński D, Smoczyński R, et al. Analysis of 75 consecutive COVID-19 ECMO cases in Warsaw Centre for extracorporeal therapies. Kardiol Pol 2021; 79: 851-4.
 
49.
Jacobs JP, Stammers AH, St Louis JD, et al. Multi-institutional analysis of 200 COVID-19 patients treated with ECMO: outcomes and trends. Ann Thorac Surg 2022; 113: 1452-60.
 
50.
Kunavarapu C, Yeramaneni S, Melo J, et al. Clinical outcomes of severe COVID-19 patients receiving early VV-ECMO and the impact of pre-ECMO ventilator use. Int J Artif Organs 2021; 44: 861-7.
 
51.
Shaefi S, Brenner SK, Gupta S, et al.; STOP-COVID Investigators. Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19. Intensive Care Med 2021; 47: 208-21.
 
52.
Bermea RS, Raz Y, Sertic F, et al. Increased intracranial hemorrhage amid elevated inflammatory markers in those with COVID-19 supported with extracorporeal membrane oxygenation. Shock 2021; 56: 206-14.
 
53.
Fröhlich GM, Jeschke E, Eichler U, et al. Impact of oral anticoagulation on clinical outcomes of COVID-19: a nationwide cohort study of hospitalized patients in Germany. Clin Res Cardiol 2021; 110: 1041-50.
 
54.
Luyt CE, Sahnoun T, Gautier M, et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Ann Intensive Care 2020; 10: 158.
 
55.
Zhang J, Merrick B, Correa GL, et al. Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series. ERJ Open Res 2020; 6: 00463-2020.
 
56.
Supady A, Weber E, Rieder M, et al. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial. Lancet Respir Med 2021; 9: 755-62.
 
57.
Lebreton G, Schmidt M, Ponnaiah M, et al.; Paris ECMO-COVID-19 investigators. Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study. Lancet Respir Med 2021; 9: 851-62.
 
58.
Cheruiyot I, Kipkorir V, Ngure B, et al. Arterial thrombosis in coronavirus disease 2019 (COVID-19) patients: a rapid systematic review. Ann Vasc Surg 2021; 70: 273-81.
 
59.
Harari R, Bangalore S, Chang E, et al. COVID-19 complicated by acute myocardial infarction with extensive thrombus burden and cardiogenic shock. Catheter Cardiovasc Interv 2021; 97: E661-6.
 
60.
Dominguez-Erquicia P, Dobarro D, Raposeiras-Roubín S, et al. Multivessel coronary thrombosis in a patient with COVID-19 pneumonia. Eur Heart J 2020; 41: 2132.
 
61.
ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization. Available at: https://www.elso.org/resources...; Accessed: 4 September 2020.
 
62.
Haiduc AA, Alom S, Melamed N, Harky A. Role of extracorporeal membrane oxygenation in COVID-19: a systematic review. J Card Surg 2020; 35: 2679-87.
 
63.
Stockmann H, Keller T, Büttner S, et al. CytoResc - “CytoSorb” Rescue for critically ill patients undergoing the COVID-19 cytokine storm: a structured summary of a study protocol for a randomized controlled trial. Trials 2020; 21: 577.
 
64.
Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol 2021; 93: 250-6.
 
65.
Ramanathan K, Shekar K, Ling RR, et al. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care 2021; 25: 211.
 
66.
Bertini P, Guarracino F, Falcone M, et al. ECMO in COVID-19 patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 2022; 36: 2700-6.
 
67.
Oliveira TF, Rocha CAO, Santos AGGD, et al. Extracorporeal membrane oxygenation in COVID-19 treatment: a systematic literature review. Braz J Cardiovasc Surg 2021; 36: 388-96.
 
68.
Badulak J, Antonini MV, Stead CM, et al; ELSO COVID-19 Working Group Members. Extracorporeal membrane oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J 2021; 67: 485-95.
 
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