Use of ECMO in Patients With Coronavirus Disease 2019: Does the Evidence Suffice?

Abstract

CORONAVIRUS DISEASE 2019 (COVID-19) is a contagious infection precipitated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. It is a novel virus of which transmissability, incidence and mortality rates have made it a global emergency. While the clinical manifestations of the virus may vary in severity, it is widely known that the cardiorespiratory system is the principle infection point of the virus, with acute respiratory distress syndrome (ARDS) and shock being possibilities. 1 Although severe and critically ill patients account for 15-26% of patients, there are currently no targeted COVID-19 therapeutics. 2 At present, supportive care forms the core of disease management, with emphasis on oxygen delivery in the early stage of the disease. 3 In March 2020, the World Health Organization (WHO) published interim guidelines recommending the use of extracorporeal membrane oxygenation (ECMO) in ARDS patients unresponsive to mainstream therapies, in order to maintain cardiorespiratory function. 4 In this letter, we present a systematic review of the literature to summarize the evidence behind using ECMO in COVID-19 patients, in accordance to the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis: (PRISMA) Guidelines. We have performed a comprehensive electronic literature search using key words "COVID-19," "SARS-CoV2," "Coronavirus," "ECMO," "Extracorporeal membrane oxygenation," "VA-ECMO," "VV-ECMO," "Outcomes," "Respiratory support," and "circulatory support," either as MeSH terms or in the combined key word formats. Our results showed a total of 102 articles that were collected from the database search and through snowballing. A total of 25 articles were selected to be included, after exclusion of duplication and subsequent screening (Fig 1). A summary of each of the chosen studies was conducted as shown in Table 1. After combining the data from the studies, 3,428 patients were diagnosed with COVID-19 overall, 612 patients were diagnosed with ARDS, and 479 were placed on ECMO, with VV-ECMO being the most commonly used type. Commonly used as a form of rescue therapy, ECMO was delivered to COVID-19 patients with induced ARDS and other

Six-Month Survival After Extracorporeal Membrane Oxygenation for Severe COVID-19

“…The early and small series of patients with ECMO for severe COVID-19 reported on excessive mortality rates with this salvage therapy. [14][15][16] Furthermore, the interpretation of the results was difficult because of incomplete follow-up of these patients. 17 Despite these discouraging initial results, experienced ECMO centers adopted an active approach toward the management of these critically ill patients and documented satisfactory early mortality rates.…”

A critical juncture in universal healthcare: insights from South Korea’s COVID-19 experience for the United Kingdom to consider

“…A patient with a severe bout of COVID-19 shows neurologic manifestations associated with MRI scans of abnormal brains (Poyiadji et al, 2020;Kremer et al, 2020) along with symptoms of anosmia, partial loss of sense of smell, or changes in taste (Aragão, et al, 2020;AlKetbi et al, 2020). Third, ECMO treatment is a process that supports someone who is undergoing respiratory failure (Royal Papworth Hospital, 2020;Alom et al, 2020). As a last resort for COVID-19 care, the ECMO treatment allows the organs to rest and recover.…”

“…Naturally, CT and MRI rooms have positive air pressure, forcing the bulk of the air out of the MRI area without allowing it to circulate back into the room based upon standard designs (Kooraki et al, 2020). Adversely, an ECMO room (or bed) has negative air pressure, with the air pressure dropping below that of outside, so air cannot escape outside (Royal Papworth Hospital, 2020; Alom et al, 2020). Moreover, the human resources needed to handle technological equipment should also be kept safe from infection.…”

Extracorporeal Membrane Oxygenation Used in Acute Respiratory Distress Syndrome with COVID-19: A Systematic Review and Meta-Analysis

“…This might be due to the use of anticoagulants during ECMO delivery, as well as systemic inflammation. As a result, coagulability levels in patients receiving ECMO need to be monitored more closely [ 39 , 40 ].…”