Extracorporeal membrane oxygenation versus mechanical ventilation alone in adults with severe acute respiratory distress syndrome: A systematic review and meta-analysis.

BACKGROUND: COVID-19 can lead to acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is considered to be a salvage strategy for severe ARDS. However, the effect of ECMO therapy on severe ARDS remains inconclusive. We aimed to evaluate the effects of ECMO for adults with severe ARDS. METHODS: We searched six databases (EMBASE, Medline, the Cochrane Library, Web of Science, Wanfang databases and CNKI) from inception to May 2020 to screen relevant high-quality observational studies and randomised controlled trials. We used the random effects model for outcome calculation. Trial sequential analysis (TSA), heterogeneity, sensitivity analysis and publication bias were explored. The primary outcome was 90-day mortality. RESULTS: Seven studies (two RCTs and five observational studies) with a total of 867 patients were included. Compared with MV therapy alone, ECMO therapy significantly reduced the mortality at 90 days (based on RCT studies, Risk Ratio [RR] 0.74, 95% confidence Interval (CI) 0.59-0.93, P = .01, I2  = 0%, moderate quality; based on observational studies, RR 0.61, 95% CI 0.46-0.81, P < .001, I2  = 0%, low quality) and at 30 and 60 days. TSA results were consistent with the primary outcome. Furthermore, device-related adverse events were similar between the ECMO group and MV alone group (RR, 2.09; 95% CI, 0.27-16.03, P = .48, I2  = 0%, moderate quality). CONCLUSIONS: This study showed that the ECMO group exhibited a significantly lower mortality rate compared with the MV alone group at 90, 30 and 60 days for severe ARDS patients.

The Development of Critical Care Medicine in China: From SARS to COVID-19 Pandemic.

BACKGROUND: Critical care medicine is a branch of medical science that deals with the characteristics and regularity of life-threatening processes initiated by any injury or disease and, accordingly, relevant treatment for patients with critical illness. Conceptions of critical care medicine in China stemmed in the early 1970s. Ever since the establishment of the first intensive care unit (ICU) along with the increasingly incomparable role of ICU in medical practices, critical care medicine has become an indispensable part of the Chinese medical and health system. Currently, critical care medicine as a secondary clinical discipline and a well-constructed science is in sustainable development on the way towards systematization and standardization. METHODS: The gross domestic product (GDP) and population data were obtained from the National Bureau of Statistics. The number of ICUs, ICU beds, and hospital beds and other data regarding ICU staffing and facility resources were obtained from the Yearbook of Health in the People's Republic of China and National Bureau of Statistics. The mortality rates of SARS and COVID-19 and the number of health workers aiding Hubei amid COVID-19 pandemic were obtained from the National Health Commission. Findings. Critical care medicine in mainland China has made significant strides: both quantity and quality are progressing at a fast pace after SARS in 2003. Although there exist some disparities in healthcare personnel and medical resources, they have not hindered the country from mobilizing its healthcare workers and resources against a public health emergency.