Citation Information :
Nagraj S, Karia R, Hassanain S, Ghosh P, Shah VR, Thomas A. Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review. Indian J Crit Care Med 2021; 25 (6):691-698.
Objectives: This systematic review aims to provide insight into the outcome of extracorporeal membrane oxygenation (ECMO) and invasive mechanical ventilation use in critically ill COVID-19 patients.
Data sources: Electronic databases PubMed Central and PubMed were searched from January 2020 to June 2020 for published studies about ECMO and/or invasive mechanical ventilation use in COVID-19 patients. Data Extraction and Study Selection: The search strategy retrieved 766 articles, of which 19 studies consisting of 204 patients fulfilled the inclusion criteria and were included in the analysis.
Data synthesis: Primary outcomes evaluated were discharge and/or clinical improvement and mortality rate. Secondary outcomes evaluated included reported complications and the mean number of days of hospitalization for survivors. Weighted averages of included studies were calculated, and data were pooled in forest plots. Nearly, 68.1% of the patients received invasive mechanical ventilation without ECMO support, and 31.9% were placed on ECMO. Also, 22.5% of the patients were discharged and/or clinically improved and 51.5% died. Twenty-six percent of the study population deteriorated but remained alive or experienced no improvement in clinical condition. And 75.2% of those who died belonged to the non-ECMO group and 24.8% to the ECMO group. The mortality rate in the non-ECMO group was 56.8% compared to 40% in the ECMO group.
Conclusion: The utility of ECMO during a pandemic is uncertain as it is a resource-intensive modality, especially when the mortality rate in severely ill patients infected with COVID-19 virus is already known to be high.
Li X, Ma X. Acute respiratory failure in COVID- 19: is it “typical” ARDS? Crit Care 2020;24(1):198. DOI: 10.1186/s13054-020-02911-9.
MacLaren G, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19: the potential role of extracorporeal membrane oxygenation. JAMA 2020;323(13):1245–1246. DOI: 10.1001/jama.2020.2342.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061–1069. DOI: 10.1001/jama.2020.1585.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507–513. DOI: 10.1016/S0140-6736(20)30211-7.
Clinical management of severe acute respiratory infection when COVID-19 is suspected [internet]; 2020. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.
Goligher EC, Tomlinson G, Hajage D, Wijeysundera D, Fan E, Jüni P, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial. JAMA 2018;320(21):2251–2259. DOI: 10.1001/jama.2018.14276.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8(5):336–341. DOI: 10.1016/j.ijsu.2010.02.007.
Study Quality Assessment Tools|National Heart, Lung, and Blood Institute (NHLBI); 2020. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.
Jacobs J, Stammers A, St. Louis J, Hayanga A, Firstenberg M, Mongero L, et al. Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise in COVID-19. ASAIO J 2020. DOI: 10.1097/MAT.0000000000001185.
Abou-Arab O, Huette P, Berna P, Mahjoub Y. Tracheal trauma after difficult airway management in morbidly obese patients with COVID-19. Br J Anaesth 2020;125(1):e168–e170. DOI: 10.1016/j.bja.2020.04.004.
Young BE, Ong SWX, Kalimuddin S, Low J, Tan S, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020;323(15):1488–1494. DOI: 10.1001/jama.2020.3204.
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020;158(6):1831–1833. DOI: 10.1053/j.gastro.2020.02.055.
Bhatraju P, Ghassemieh B, Nichols M, Kim R, Jerome K, Nalla A, et al. Covid-19 in critically ill patients in the Seattle region — case series. N Engl J Med 2020;382(21):2012–2022. DOI: 10.1056/NEJMoa2004500.
Zhang B, Liu S, Tan T, Huang W, Dong Y, Chen L, et al. Treatment with convalescent plasma for critically ill patients with SARS-CoV-2 infection. Chest 2020;158(1):e9-e13. DOI: 10.1016/j.chest.2020.03.039.
Zeng Y, Cai Z, Xianyu Y, Yang B, Song T, Yan Q. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series. Crit Care 2020;24(1):148. DOI: 10.1186/s13054-020-2840-8.
Taniguchi H, Ogawa F, Honzawa H, Yamaguchi K, Niida S, Shinohara M, et al. Veno‐venous extracorporeal membrane oxygenation for severe pneumonia: COVID‐19 case in Japan. Acute Med Surg 2020;7(1):509. DOI: 10.1002/ams2.509.
Wang R, Pan M, Zhang X, Han M, Fan X, Zhao F, et al. Epidemiological and clinical features of 125 hospitalized patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis 2020;95:421–428. DOI: 10.1016/j.ijid.2020.03.070.
Nakamura K, Hikone M, Shimizu H, Kuwahara Y, Tanabe M, Kobayashi M, et al. A sporadic COVID-19 pneumonia treated with extracorporeal membrane oxygenation in Tokyo, Japan: a case report. J Infect Chemother 2020;26(7):756–761. DOI: 10.1016/j.jiac.2020.03.018.
Ren L, Wang Y, Wu Z, Xiang Z, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human. Chin Med J (Engl) 2020;133(9):1015–1024. DOI: 10.1097/CM9.0000000000000722.
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8(5):475–481. DOI: 10.1016/S2213-2600(20)30079-5.
Barrasa H, Rello J, Tejada S, Martin A, Balziskueta G, Vinuesa C, et al. SARS-CoV-2 in Spanish Intensive Care Units: early experience with 15-day survival in Vitoria. Anaesth Crit Care PA 2020;39(5):553–561. DOI: 10.1016/j.accpm.2020.04.001.
Ma J, Xia P, Zhou Y, Liu Z, Zhou X, Wang J, et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. J Clin Immunol 2020;214:108408. DOI: 10.1016/j.clim.2020.108408.
Zhang L, Li J, Zhou M, Chen Z. Summary of 20 tracheal intubation by anesthesiologists for patients with severe COVID-19 pneumonia: retrospective case series. J Anesth 2020;34(4):599–606. DOI: 10.1007/s00540-020-02778-8.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA 2020;323(16):1582–1589. DOI: 10.1001/jama.2020.4783.
Liu C, Wu C, Zheng X, Zeng F, Liu J, Wang P, et al. Clinical features and multidisciplinary treatment outcome of COVID-19 pneumonia: a report of three cases. J Formos Med Assoc 2020;119(11):1702–1709. DOI: 10.1016/j.jfma.2020.04.008.
Ferrey A, Choi G, Hanna R, Chang Y, Tantisattamo E, Ivaturi K, et al. A case of novel coronavirus disease 19 in a chronic hemodialysis patient presenting with gastroenteritis and developing severe pulmonary disease. Am J Nephrol 2020;51(5):337–342. DOI: 10.1159/000507417.
Alshahrani M, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care 2018;8(1):3. DOI: 10.1186/s13613-017-0350-x.
Extracorporeal Life Support Organization (ELSO) guidelines for adult respiratory failure; 2017. Available from: https://www.elso.org/Portals/0/ELSO%20Guidelines%20For%20Adult%20Respiratory%20Failure%201_4.pdf.
Extracorporeal Life Support Organization COVID-19 interim guidelines; 2020. Available from: https://www.elso.org/Portals/0/Files/pdf/ELSO%20covid%20guidelines%20final.pdf.
Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med 2020;8(5):518–526. DOI: 10.1016/S2213-2600(20)30121-1.
Richardson S, Hirsch JS, Narasimhan M, Crawford J, McGinn T, Davidson K, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020;323(20):2052–2059. DOI: 10.1001/jama.2020.6775.
Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018;378:1965–1975. DOI: 10.1056/NEJMoa1800385.
Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med 2019;7(2):163–172. DOI: 10.1016/S2213-2600(18)30452-1.
Brodie D, Slutsky AS, Combes A: Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA 2019;322:557–568. DOI: 10.1001/jama.2019.9302.
Peek G, Mugford M, Tiruvoipati T, Wilson A, Allen E, Thalanany M, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374(9698):1351–1363. DOI: 10.1016/S0140-6736(09)61069-2.
Japan ECMsOnet for. Nationwide system to centralize decisions around ECMO use for severe COVID-19 pneumonia in Japan (special correspondence). J. Intensive Care 2020;8(1):29. DOI: 10.1186/s40560-020-00445-4.
Barbaro RP, Odetola FO, Kidwell KM, Paden M, Bartlett R, David M, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. analysis of the Extracorporeal Life Support Organization registry. Am J Respir Crit Care Med 2015;191(8):894–901. DOI: 10.1164/rccm.201409-1634OC.