ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis

OBJECTIVE: To analyze the survival rates of patients with COVID-19 supported with extracorporeal membrane oxygenation (ECMO) and compare the survival rates of patients with COVID-19 supported with ECMO to patients with influenza supported with ECMO. DESIGN: A systematic review and meta-analysis to assess the impact of ECMO as supportive therapy of COVID-19. SETTING: The authors performed a search through the Cochrane, EMBASE, and MEDLINE/PubMed databases from inception to February 19, 2021, for studies reporting hospitalized patients with COVID-19 managed with ECMO. PARTICIPANTS: A total of 134 studies were selected, including 6 eligible for the comparative meta-analysis of COVID-19 versus influenza. INTERVENTIONS: The authors pooled the risk ratio and random effects model. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the overall mortality of patients with COVID-19 receiving ECMO. Of the total number of 58,472 patients with COVID-19 reported, ECMO was used in 4,044 patients. The analysis suggested an overall in-hospital mortality of 39% (95% CI 0.34-0.43). In the comparative analysis, patients with COVID-19 on ECMO had a higher risk ratio (RR) for mortality when compared to influenza patients on ECMO: 72/164 (44%) v 71/186 (38%) RR 1.34; 95% CI 1.05-1.71; p = 0.03. CONCLUSIONS: ECMO could be beneficial in patients with COVID-19, according to the authors’ meta-analysis. The reported mortality rate was 39%. This systematic analysis can provide clinical advice in the current era and ongoing pandemic.