Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2022; 10(8): 2457-2467
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2457
Mortality in patients with COVID-19 requiring extracorporeal membrane oxygenation: A meta-analysis
Ye Zhang, Lei Wang, Zhi-Xian Fang, Jing Chen, Jia-Lian Zheng, Ming Yao, Wen-Yu Chen
Ye Zhang, Lei Wang, Department of General Practice, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Zhi-Xian Fang, Wen-Yu Chen, Department of Respiration, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Jing Chen, Jia-Lian Zheng, Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Ming Yao, Department of Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Author contributions: Zhang Y, Wang L, and Fang ZX conceptualised and designed the protocol, drafted the initial manuscript, and reviewed the manuscript; Chen J and Zheng JL defined the concepts and search items, data extraction process, as well as methodological appraisal of the studies; Yao M planned the data extraction and statistical analysis; Chen WY provided critical insights; all authors have approved and contributed to the final written manuscript.
Supported by The Jiaxing Fight Novel Coronavirus Pneumonia Emergency Technology Attack Special Project in 2020, No. 2020GZ30001; the Key Discipline of Jiaxing Respiratory Medicine Construction Project, No. 2019-zc-04; Scientific Technology Plan Program for Healthcare in Zhejiang Province, No. 2021KY1100; and A Project Supported by Scientific Research Fund of Zhejiang Provincial Education Department, No.Y202043573 and No. Y202043729.
Conflict-of-interest statement: All the authors report no conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Yu Chen, PhD, Department of Respiration, Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing 314000, Zhejiang Province, China. 00135116@zjxu.edu.cn
Received: July 27, 2021
Peer-review started: July 27, 2021
First decision: October 22, 2021
Revised: November 4, 2021
Accepted: January 29, 2022
Article in press: January 29, 2022
Published online: March 16, 2022
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and significant public health issue. The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been called into question.

AIM

To conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.

METHODS

This analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) and has been registered at the International Prospective Register of Systematic Reviews (number CRD42020227414). A quality assessment for all the included articles was performed by the Newcastle-Ottawa Scale (NOS). Studies with tenor more COVID-19 patients undergoing ECMO were included. The random-effects model was used to obtain the pooled incidence of mortality in COVID-19 patients receiving ECMO. The source of heterogeneity was investigated using subgroup and sensitivity analyses.

RESULTS

We identified 18 articles with 1494 COVID-19 patients who were receiving ECMO. The score of the quality assessment ranged from 5 to 8 on the NOS. The majority of patients received veno-venous ECMO (93.7%). Overall mortality was estimated to be 0.31 [95% confidence interval (CI): 0.24-0.39; I2 = 84.8%] based on random-effect pooled estimates. There were significant differences in mortality between location groups (33.0% vs 55.0% vs 37.0% vs 18.0%, P < 0.001), setting groups (28.0% vs 34.0%, P < 0.001), sample size (37.0% vs 31.0%, P < 0.001), and NOS groups (39.0% vs 19.0%, P < 0.001). However, both subgroup analyses based on location, setting, and sample size, and sensitivity analysis failed to identify the source of heterogeneity. The funnel plot indicated no evident asymmetry, and the Egger's (P = 0.95) and Begg's (P = 0.14) tests also revealed no significant publication bias.

CONCLUSION

With more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.

Keywords: COVID-19, Extracorporeal membrane oxygenation, SARS-CoV-2, Meta-analysis, Veno-venous extracorporeal membrane oxygenation, Mortality

Core Tip: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and significant public health issue. The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been called into question. Therefore, we conducted this meta-analysis on the mortality of COVID-19 patients who require ECMO. We identified 18 articles with 1494 COVID-19 patients who were receiving ECMO. With more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.