Nagraj Sanjana, Karia Rutu, Hassanain Sahar, Ghosh Prithwish, Shah Viraj R, Thomas Abin
Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, United States.
Department of Internal Medicine, Anna Medical College and Research Centre, Montagne Blanche, Mauritius.
Indian J Crit Care Med. 2021 Jun;25(6):691-698. doi: 10.5005/jp-journals-10071-23870.
This systematic review aims to provide insight into the outcome of extracorporeal membrane oxygenation (ECMO) and invasive mechanical ventilation use in critically ill COVID-19 patients.
Electronic databases PubMed Central and PubMed were searched from January 2020 to June 2020 for published studies about ECMO and/or invasive mechanical ventilation use in COVID-19 patients. Data Extraction and Study Selection: The search strategy retrieved 766 articles, of which 19 studies consisting of 204 patients fulfilled the inclusion criteria and were included in the analysis.
Primary outcomes evaluated were discharge and/or clinical improvement and mortality rate. Secondary outcomes evaluated included reported complications and the mean number of days of hospitalization for survivors. Weighted averages of included studies were calculated, and data were pooled in forest plots. Nearly, 68.1% of the patients received invasive mechanical ventilation without ECMO support, and 31.9% were placed on ECMO. Also, 22.5% of the patients were discharged and/or clinically improved and 51.5% died. Twenty-six percent of the study population deteriorated but remained alive or experienced no improvement in clinical condition. And 75.2% of those who died belonged to the non-ECMO group and 24.8% to the ECMO group. The mortality rate in the non-ECMO group was 56.8% compared to 40% in the ECMO group.
The utility of ECMO during a pandemic is uncertain as it is a resource-intensive modality, especially when the mortality rate in severely ill patients infected with COVID-19 virus is already known to be high.
Nagraj S, Karia R, Hassanain S, Ghosh P, Shah VR, Thomas A. Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(6):691-698.
本系统评价旨在深入了解体外膜肺氧合（ECMO）和有创机械通气在危重症新型冠状病毒肺炎（COVID-19）患者中的应用结局。
于2020年1月至2020年6月检索电子数据库美国国立医学图书馆核心期刊数据库（PubMed Central）和美国国立医学图书馆数据库（PubMed）中关于COVID-19患者使用ECMO和/或有创机械通气的已发表研究。数据提取与研究选择：检索策略共检索到766篇文章，其中19项研究（共204例患者）符合纳入标准并纳入分析。
评估的主要结局为出院和/或临床改善情况以及死亡率。评估的次要结局包括报告的并发症以及幸存者的平均住院天数。计算纳入研究的加权平均值，并将数据汇总于森林图中。近68.1%的患者在没有ECMO支持的情况下接受了有创机械通气，31.9%的患者接受了ECMO治疗。此外，22.5%的患者出院和/或临床改善，51.5%的患者死亡。26%的研究人群病情恶化但仍存活或临床状况无改善。死亡患者中，75.2%属于非ECMO组，24.8%属于ECMO组。非ECMO组的死亡率为56.8%，而ECMO组为40%。
在大流行期间ECMO的效用尚不确定，因为它是一种资源密集型方式，尤其是当已知感染COVID-19病毒的重症患者死亡率已经很高时。
纳格拉吉S，卡里亚R，哈桑奈因S，戈什P，沙阿VR，托马斯A。有创机械通气和ECMO在COVID-19管理中的作用：一项系统评价。《印度重症监护医学杂志》2021；25（6）：691 - 698。
