Extracorporeal membrane oxygenation for COVID-19 and influenza associated acute respiratory distress syndrome: a systematic review

ABSTRACT

Background

Extracorporeal membrane oxygenation (ECMO) has been used extensively for H1N1 influenza and coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) to improve gas exchange and quickly correct hypoxemia and hypercapnia. This systematic review summarized the evidence on ECMO for the treatment of COVID-19 and influenza-associated ARDS.

Research design and methods

This is a systematic review and meta-analysis of studies to compare the efficacy and safety of ECMO with conventional mechanical ventilation in adults with COVID-19 and influenza-associated ARDS. The study performed a structured search on PubMed, Embase, Web of Science, Scopus and The Cochrane Library. The primary outcome was hospital mortality.

Results

The study included 15 observational studies with 5239 patients with COVID-19 and influenza-associated ARDS. The use of ECMO significantly reduced in-hospital mortality in COVID-19-associated ARDS (OR = 0.40; 95% CI = 0.27–0.58; P < 0.00001) but did not reduce influenza-related mortality (OR = 1.08; 95% CI = 0.41–2.87; P = 0.87). Moreover, ECMO treatment meaningfully increased the incidence of bleeding complications (OR = 7.66; 95% CI = 2.47–23.72; P = 0.0004).

Conclusion

The use of ECMO significantly reduced in-hospital mortality in COVID-19- associated ARDS, which may be related to the advances in ECMO-related techniques and the increased experience of clinicians. However, the incidence of bleeding complications remains high.

KEYWORDS:

• Extracorporeal membrane oxygenation
• acute respiratory distress syndrome
• COVID-19
• influenza
• mortality
• adverse events

Author contributions

Y Zhang and L Wang conceived of the study. L Wang and D Wang screened the literature and extracted data. L Wang and Y He performed the quality appraisal. T Zhang resolved any disagreements in study relevancy, extraction, and quality appraisal. LW drafted and revised the manuscript. H Fan and Y Zhang directed and revised the manuscript. All authors read and approved the final manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Graphical Abstract figure was made by Figdraw.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2272704

Additional information

Funding

This study was funded by the Sichuan Science and Technology Program (2022YFS0261).