Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Expert Recommendations from The Korean Society for Thoracic and Cardiovascular Surgery

Jeong, In-Seok; Baek, Jong Hyun; Choi, Chang-Hyu; Choi, Chang Woo; Chung, Eun Cheol; Jang, Jae Seok; Jang, Woo Sung; Jung, Hanna; Jung, Jae Seung; Kang, Pil Je; Kim, Dong Jung; Kim, Dowan; Kim, Hyoung Soo; Kim, Jae-Bum; Kim, Woo-Shik; Kim, Young Sam; Kwak, Jae Gun; Lee, Haeyoung; Lee, Seok In; Lim, Jae Woong; Oh, Se Jin; Oh, Tak-Hyuk; Park, Chun Soo; Ryu, Kyoung Min; Shim, Man-shik; Son, Jung Beom; Son, Kuk Hui; Song, Seunghwan

doi:10.5090/kjtcs.21.001

Cited by 2 publications

(2 citation statements)

References 30 publications

(33 reference statements)

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“…Concurrently, the mortality rate for patients with non-COVID-19related acute respiratory failure who required any form of ECMO, including veno-arterial ECMO, was approximately 57.6% (19/33) [20]. However, in this current study, the in-hospital mortality rate for patients with COVID-19 who were supported by ECMO (76.9%) exceeded both this pre-pandemic mortality rate and the mortality rates previously reported for COVID-19 patients receiving ECMO (37%-55%) [8,21]. Most prior studies have primarily been focused on patients receiving veno-venous ECMO support.…”

Section: Discussioncontrasting

confidence: 66%

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

Kim,

Lim,

et al. 2023

J Chest Surg

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Background Coronavirus disease 2019 (COVID-19) can lead to acute respiratory failure, which frequently necessitates invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, the limited availability of ECMO resources poses challenges to patient selection and associated decision-making. Consequently, this retrospective single-center study was undertaken to evaluate the characteristics and clinical outcomes of patients with COVID-19 receiving ECMO. Methods Between March 2020 and July 2022, 65 patients with COVID-19 were treated with ECMO and were subsequently reviewed. Patient demographics, laboratory data, and clinical outcomes were examined, and statistical analyses were performed to identify risk factors associated with mortality. Results Of the patients studied, 15 (23.1%) survived and were discharged from the hospital, while 50 (76.9%) died during their hospitalization. The survival group had a significantly lower median age, at 52 years (interquartile range [IQR], 47.5–61.5 years), compared to 64 years (IQR, 60.0–68.0 years) among mortality group (p=0.016). However, no significant differences were observed in other underlying conditions or in factors related to intervention timing. Multivariable analysis revealed that the requirement of a change in ECMO mode (odds ratio [OR], 366.77; 95% confidence interval [CI], 1.92–69911.92; p=0.0275) and the initiation of continuous renal replacement therapy (CRRT) (OR, 139.15; 95% CI, 1.95–9,910.14; p=0.0233) were independent predictors of mortality. Conclusion Changes in ECMO mode and the initiation of CRRT during management were associated with mortality in patients with COVID-19 who were supported by ECMO. Patients exhibiting these factors require careful monitoring due to the potential for adverse outcomes.

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Section: Discussioncontrasting

confidence: 66%

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

Kim,

Lim,

et al. 2023

J Chest Surg

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“…However, according to the EOLIA trial, the ELSO made a standard recommendation that ECMO therapy could be used in certain patients with COVID-19 [6]. Subsequently, the Korean Society for Thoracic and Cardiovascular Surgery (KSTCVS) [93] and Chinese experts [94][95][96] have also recommended ECMO as a salvage therapy for patients with severe COVID-19 who have not responded to conventional ARDS therapy.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

Tan,

Su,

Chen

et al. 2024

JCM

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Background: Coronavirus disease 2019 (COVID-19) is the etiology of acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used to support gas exchange in patients who have failed conventional mechanical ventilation. However, there is no clear consensus on the timing of ECMO use in severe COVID-19 patients. Objective: The aim of this study is to compare the differences in pre-ECMO time and ECMO duration between COVID-19 survivors and non-survivors and to explore the association between them. Methods: PubMed, the Cochrane Library, Embase, and other sources were searched until 21 October 2022. Studies reporting the relationship between ECMO-related time and COVID-19 survival were included. All available data were pooled using random-effects methods. Linear regression analysis was used to determine the correlation between pre-ECMO time and ECMO duration. The meta-analysis was registered with PROSPERO under registration number CRD42023403236. Results: Out of the initial 2473 citations, we analyzed 318 full-text articles, and 54 studies were included, involving 13,691 patients. There were significant differences between survivors and non-survivors in the time from COVID-19 diagnosis (standardized mean difference (SMD) = −0.41, 95% confidence interval (CI): [−0.53, −0.29], p < 0.00001), hospital (SMD = −0.53, 95% CI: [−0.97, −0.09], p = 0.02) and intensive care unit (ICU) admission (SMD = −0.28, 95% CI: [−0.49, −0.08], p = 0.007), intubation or mechanical ventilation to ECMO (SMD = −0.21, 95% CI: [−0.32, −0.09], p = 0.0003) and ECMO duration (SMD = −0.18, 95% CI: [−0.30, −0.06], p = 0.003). There was no statistical association between a longer time from symptom onset to ECMO (hazard ratio (HR) = 1.05, 95% CI: [0.99, 1.12], p = 0.11) or time from intubation or mechanical ventilation (MV) and the risk of mortality (highest vs. lowest time groups odds ratio (OR) = 1.18, 95% CI: [0.78, 1.78], p = 0.42; per one-day increase OR = 1.14, 95% CI: [0.86, 1.52], p = 0.36; HR = 0.99, 95% CI: [0.95, 1.02], p = 0.39). There was no linear relationship between pre-ECMO time and ECMO duration. Conclusion: There are differences in pre-ECMO time between COVID-19 survivors and non-survivors, and there is insufficient evidence to conclude that longer pre-ECMO time is responsible for reduced survival in COVID-19 patients. ECMO duration differed between survivors and non-survivors, and the timing of pre-ECMO does not have an impact on ECMO duration. Further studies are needed to explore the association between pre-ECMO and ECMO time in the survival of COVID-19 patients.

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Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Expert Recommendations from The Korean Society for Thoracic and Cardiovascular Surgery

Cited by 2 publications

References 30 publications

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

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