Extracorporeal Membrane Oxygenation (ECMO) Dependent Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a newer method for managing severe acute respiratory distress syndrome (ARDS) and ARDS refractory to conventional management. However, its current role in the management of ARDS is not clear. Therefore, we conducted this metaanalysis to compare the mortality rates of ECMO over conventional management in ARDS.Methods: PubMed, PubMed Central, Embase, and Scopus were searched using appropriate keywords. We selected studies in adults with ARDS that compared the outcomes of patients treated with ECMO vs. conventional management. Cochrane Risk of Bias (RoB) 2.0 and the JBI (Joanna Briggs Institute) quality assessment tools were used for assessing the risk of bias in RCTs and observational studies, respectively. The I 2 statistic was used to evaluate heterogeneity, and quantitative synthesis was performed using fixed or random effects to pool studies based on heterogeneities. Meta-analysis was conducted using Revman 5.4.Result: Twelve studies were included in this meta-analysis. As compared to the conventional management (mechanical ventilation: MV), patients treated with ECMO had lower odds of 30-days mortality (OR, 0.56; 95% CI, 0.37 to 0.84) and 90 days mortality (OR, 0.59; 95% CI, 0.41 to 0.85). However, there was no significant difference between in-hospital mortality (OR, 0.75; 95% CI, 0.40 to 1.41) and intensive care unit (ICU) mortality (OR, 1.00; 95% CI, 0.36 to 2.79). Similarly, length of hospital stays (LOS) (MD, 3.92; 95% CI, -6.26 to 14.11) did not show statistically significant differences across the two groups. However, the average ICU stay (ICU LOS) was 7.28 days longer in the ECMO group compared with the MV group (MD, 7.28; 95% CI, 2.55 to 12.02).Conclusion: Twenty-eight days and 90-days mortality were decreased in patients managed with ECMO compared with the MV group. Also, ICU LOS was found to be longer in the ECMO group. Furthermore, no statistical difference was found between the two groups for in-hospital mortality and hospital LOS.

Extracorporeal membrane oxygenation technology for adults: an evidence mapping based on systematic reviews

“…A total of 321 articles were deemed ineligible after thoroughly examining of their full text due to non-compliance with the established eligibility criteria. Ultimately, a total of 17 SRs with or without a meta-analysis on ECMO were included for systematic scoping review and evidence synthesis [ 22 – 38 ]. Figure 1 displays all comprehensive review processes, exclusion numbers, and reasons for full-text exclusions.…”

“…SRs exhibited variation in their country of origin, with the greatest frequency being observed for Canada [ 24 , 27 , 28 , 31 , 34 ] ( n = 5). Other nations represented were the United States [ 22 , 33 , 35 , 38 ] ( n = 4), Italy [ 23 , 37 ] ( n = 2), China [ 36 ] ( n = 1), Brazil [ 30 ] ( n = 1), France [ 32 ] ( n = 1), Korea [ 25 ] ( n = 1), Netherlands [ 26 ] ( n = 1), and United Kingdom [ 29 ] ( n = 1).…”

“…The majority of SRs ( n = 12) included more than 1000 participants. There was a wide variety of clinical topics in the included SRs, including acute respiratory distress syndrome (ARDS) [ 31 ] ( n = 1), dependent ARDS [ 38 ] ( n = 1), severe ARDS [ 27 , 30 , 32 , 36 ] ( n = 4), acute respiratory failure (ARF) [ 24 ] ( n = 1), ARF due to H1N1 influenza pandemic [ 22 ] ( n = 1), acute lung injury (ALI) due to H1N1 influenza infection [ 23 ] ( n = 1), acute liver failure (ALF) or acute on chronic liver failure (ACLF) [ 34 ] ( n = 1), cardiac arrest [ 26 , 28 , 29 , 33 , 35 , 37 ] ( n = 6), and cardiac arrest of cardiac origin [ 25 ] ( n = 1). The numbers of primary studies and participants are shown in Table 1 .…”

“…of included RCTs No. of participants Outcome Conclusion Munshi 2019 [ 31 ] ARDS RCT, observational study 5 2 899 60-Day mortality, treatment failure, mortality at longest available follow-up Probably beneficial Shrestha 2022 [ 38 ] Dependent ARDS RCT, retrospective study, prospective observational study, cohort study 12 2 1208 30-Day mortality, 90-day mortality, in-hospital mortality, ICU mortality, length of hospital stays, average ICU length of stay Inconclusive Tillmann 2017 [ 27 ] Severe ARDS RCT, cohort study 26 1 1674 Survival, adverse events Inconclusive Mendes Pedro Vitale, 2019 [ 30 ] Severe ARDS RCT 2 2 429 Mortality, treatment failure, need for renal replacement therapy, ICU lengths of stay, hospital lengths of stay Probably beneficial Alain Combes, 2020 [ 32 ] Severe ARDS RCT 2 2 429 90-Day mortality, 90-day treatment failure, 28-day mortality, 60-day mortality, ICU-free days, hospital-free days, ventilation-free days, vasopressor-free days, RRT-free days, neurological failure-free days Beneficial Zhu, 2021 [ 36 ] Severe ARDS RCT, retrospective or prospective cohort study...…”

The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action

“…ECMO utilization for respiratory failure refractory to medical management has expanded [ 152 , 153 , 154 ], yet many questions remain regarding potential benefits, including appropriate implementation and management [ 155 ]. First, limited randomized work exists elucidating selection of patients with respiratory failure that may benefit from ECMO.…”