The use of venovenous extracorporeal membrane oxygenation in COVID-19: An updated systematic review and meta-analysis of clinical outcomes
Perfusion
; 38(1 Supplement):155, 2023.
Article
in English
| EMBASE | ID: covidwho-20235215
ABSTRACT
Objectives:
The objective of this study is to assess the clinical benefits and potential risks of using venovenous extracorporeal membrane oxygenation (VV ECMO) as a treatment for COVID-19 patients with severe respiratory failure. Method(s) Relevant studies were identified through searches of electronic databases, including PubMed, EMBASE, and the Cochrane Library, from January 2020 to December 2022. We included observational studies on adult patients who received venovenous (VV) ECMO support for COVID-19-induced ARDS. The primary outcome was in-hospital mortality, 3-month mortality, and complications associated with VV ECMO. Statistical analysis was performed using R version 4.0.3 and the metafor and meta packages. Result(s) The final analysis included 39 studies comprising 10,702 patients. In-hospital mortality for adults receiving ECMO was 34.2% (95% CI 28.5% - 40.3%;I2 = 93%), while the 3-month mortality rate was 50.2% (95% CI 44.4% - 56.0%;I2 = 51%). Bleeding requiring transfusion occurred in 33.7% of patients (95% CI, 23.9 - 45.1;I2 = 96%). The pooled estimates for other complications were as follows overall thromboembolic events 40.9% (95% CI, 24.8 - 59.3;I2 = 97%), stroke 8.7% (95% CI, 5.7 - 13.2;I2 = 72%), deep vein thrombosis 15.4% (95% CI, 9.7 - 23.6;I2 = 80%), pulmonary embolism 15.6% (95% CI, 9.3 - 25.1;I2 = 92%), gastrointestinal haemorrhage 8.1% (95% CI, 5.5 - 11.8;I2 = 56%), and the need for any renal replacement therapy in 38.0% of patients (95% CI, 31.6 - 44.8;I2 = 84%). Bacterial pneumonia occurred in 46.4% of patients (95% CI, 32.5 - 61.0;I2 = 96%). Conclusion(s) Venovenous extracorporeal membrane oxygenation (VV ECMO) may be an effective treatment option for COVID-19 patients with severe respiratory failure. The use of VV ECMO was associated with reduced in-hospital and 3-month mortality. However, bleeding is a common complication that should be closely monitored. Further research is needed to determine the optimal use of VV ECMO in this patient population and to identify factors that may predict a favourable response to treatment.
adult; adult respiratory distress syndrome; bacterial pneumonia; cerebrovascular accident; clinical outcome; Cochrane Library; complication; conference abstract; controlled study; coronavirus disease 2019; deep vein thrombosis; Embase; female; gastrointestinal hemorrhage; human; in-hospital mortality; lung embolism; male; Medline; meta analysis; mortality; mortality rate; observational study; outcome assessment; renal replacement therapy; respiratory failure; risk assessment; systematic review; thromboembolism; treatment response; veno-venous ECMO
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Observational study
/
Prognostic study
/
Reviews
/
Systematic review/Meta Analysis
Language:
English
Journal:
Perfusion
Year:
2023
Document Type:
Article
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