Mortality rate in patients with SAR-COV-2 infection treated with extracorporeal membrane oxygenator: A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Extracorporeal membrane oxygenator (ECMO) is one of the life-saving modalities for the treatment of multiple organs dysfunction, particularly the heart and the lungs. OBJECTIVE: To evaluate the benefit of ECMO for the treatment of SAR-COV-2 infection and its outcomes, complications, and mortality rate. METHODS: A comprehensive search for articles was performed using MEDLINE and SCOPUS from December 2019 to December 2020. Two independent reviewers selected eligible studies, extracted the data, assessed the quality of the studies, reviewed the full study protocols, and reported the findings according to the PRISMA protocol. The meta-analyses were performed using the Comprehensive Meta-Analysis software version 2.0. RESULTS: Pooled data from 57 studies was analyzed. There were 7,035 patients with SAR-COV-2 infection with event rate of ECMO treatment was 58.10% (95%CI 43.70-71.20). The mortality rate was 16.66% (95%CI 11.49-23.53). The mean mortality rate of ECMO supported patients was 35.60% (95%CI 30.60 to 41.00). Thirty-one percent (95%CI 24.50-38.40) of the patients had venous thromboembolic events, 30.90% (95%CI 17.90-47.80) of the patients had ECMO circuit thrombosis, and 24.50% (95%CI 12.50-42.40) of the patients had bleeding. In the subgroup analysis, the mortality rate was higher among patients who were treated with ECMO, the pooled odds ratio was 4.47 (95%CI 2.39-8.35, p < 0.001), and was significantly higher in Asia with an odds ratio of 7.88 (95%CI 2.40-25.85, p = 0.001). CONCLUSION: Mortality rate among patients who received ECMO therapy was high. A system of care, including patient selection, resource management and referral system, can impact the outcomes of ECMO therapy.