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Kollengode Ramanathan
National University Singapore Yong Loo Lin School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1822-9455
License:
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Background: There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research.
Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases from 1st December 2019 to 10th January 2021 for observational studies or randomized clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and metaregression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO.
Results: We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI: 32.3%-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI: 30.7%-40.7%, high certainty). Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI: 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI:50.5%-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common.
Conclusion: Majority of patients received ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1%, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS.
PROSPERO CRD42020192627
Keywords
Extracorporeal membrane oxygenation, acute respiratory distress syndrome, COVID-19, SARS-CoV-2
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- ECMOCOVIDFINALSupplementaryMaterial.docx
- SupplementaryFigure1FunnelPlot.eps
Supplementary Figure 1. Funnel plot for primary meta-analysis
- SupplementaryFigure2RegionalVariation.eps
Supplementary Figure 2. Proportion of nonsurvivors among COVID-19 patients supported with ECMO stratified by geographical region
- SupplementaryFigure3BubblePlotAge.eps
Supplementary Figure 3. Bubble plot correlating mean age and proportion of non-survivors
- SuppFigure4BubbleplotBMI.eps
Supplementary Figure 4. Bubble plot correlating mean BMI and proportion of non-survivors
- SupplementaryFigure5BubblePlotECMODuration.eps
Supplementary Figure 5. Bubble plot correlating ECMO duration and proportion of non-survivors
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CURRENT STATUS: Under Review
Version 1
Posted 05 Apr, 2021
No community comments so far
Editorial decision: Minor revision
On 19 May, 2021
Review #2 received
Received 16 May, 2021
Reviewer #2 agreed
On 07 May, 2021
Review #1 received
Received 11 Apr, 2021
Reviewer #1 agreed
On 01 Apr, 2021
Reviewers invited
Invitations sent on 31 Mar, 2021
Editor invited
On 30 Mar, 2021
Editor assigned
On 29 Mar, 2021
Submission checks complete
On 29 Mar, 2021
First submitted
On 28 Mar, 2021
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Subject Areas
Critical Care & Emergency Medicine
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A new preprint design is coming!
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This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Kollengode Ramanathan
National University Singapore Yong Loo Lin School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1822-9455
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 05 Apr, 2021
No community comments so far
Editorial decision: Minor revision
On 19 May, 2021
Review #2 received
Received 16 May, 2021
Reviewer #2 agreed
On 07 May, 2021
Review #1 received
Received 11 Apr, 2021
Reviewer #1 agreed
On 01 Apr, 2021
Reviewers invited
Invitations sent on 31 Mar, 2021
Editor invited
On 30 Mar, 2021
Editor assigned
On 29 Mar, 2021
Submission checks complete
On 29 Mar, 2021
First submitted
On 28 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research.
Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases from 1st December 2019 to 10th January 2021 for observational studies or randomized clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and metaregression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO.
Results: We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI: 32.3%-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI: 30.7%-40.7%, high certainty). Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI: 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI:50.5%-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common.
Conclusion: Majority of patients received ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1%, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS.
PROSPERO CRD42020192627
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- ECMOCOVIDFINALSupplementaryMaterial.docx
- SupplementaryFigure1FunnelPlot.eps
Supplementary Figure 1. Funnel plot for primary meta-analysis
- SupplementaryFigure2RegionalVariation.eps
Supplementary Figure 2. Proportion of nonsurvivors among COVID-19 patients supported with ECMO stratified by geographical region
- SupplementaryFigure3BubblePlotAge.eps
Supplementary Figure 3. Bubble plot correlating mean age and proportion of non-survivors
- SuppFigure4BubbleplotBMI.eps
Supplementary Figure 4. Bubble plot correlating mean BMI and proportion of non-survivors
- SupplementaryFigure5BubblePlotECMODuration.eps
Supplementary Figure 5. Bubble plot correlating ECMO duration and proportion of non-survivors
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