Current best evidence for clinical care (more info)
OBJECTIVE: We aimed to examine the literature evidence behind using extracorporeal membrane oxygenation in COVID-19 patients in a systematic review manner.
METHODS: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was conducted on Global Health Medline, EMBASE, and Cochrane databases using keywords and MeSH terms to identify articles pertaining to extracorporeal membrane oxygenation (ECMO) and Coronavirus disease 2019 (COVID-19). A narrative synthesis was then undertaken to identify the key themes.
RESULTS: A total of 25 articles met the inclusion criteria of this systematic review. Three main themes were identified following the data extraction: (a) evidence against/inconclusive regarding ECMO for COVID-19, (b) evidence supporting ECMO for COVID-19, and finally (c) VV-ECMO and VA-ECMO. After combining the data, there were 3428 patients diagnosed with COVID-19 and 95 ECMO-associated deaths (19.83%).
CONCLUSION: Our study highlights the paucity of evidence and the need for further data to consolidate the efficacy of ECMO in improving patient outcomes. Although ECMO has been shown to be beneficial in a selected group of patients, the recuperative effects of ECMO remain inconclusive. We must ensure that risk-benefit analysis for each candidate is conducted thoroughly so that patients that have increased probability of survival can benefit from this scarce resource.
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What little information available is cautiously reviewed. There is no really controlled data. This is an interesting possibility but it's still a question of "you pay your money and state your choice". Nobody has an answer, yet.
Systematic reviews simply conclude that there is no evidence are not particularly helpful.
This is the most up to date evaluation of using ECMO in COVID 19. It outlines nicely the deficiencies in our understanding of when it should be applied in this situation. Nevertheless, the application algorithm the authors propose seems to hold in our practice. Earlier implementation of ECMO and younger age have resulted in some remarkable recoveries.