Zhang Ye, Wang Lei, Fang Zhi-Xian, Chen Jing, Zheng Jia-Lian, Yao Ming, Chen Wen-Yu
Department of General Practice, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
Department of Respiration, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
World J Clin Cases. 2022 Mar 16;10(8):2457-2467. doi: 10.12998/wjcc.v10.i8.2457. Epub 2022 Jan 16.
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.
To conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.
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.
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; = 84.8%] based on random-effect pooled estimates. There were significant differences in mortality between location groups (33.0% 55.0% 37.0% 18.0%, < 0.001), setting groups (28.0% 34.0%, < 0.001), sample size (37.0% 31.0%, < 0.001), and NOS groups (39.0% 19.0%, < 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 ( = 0.95) and Begg's ( = 0.14) tests also revealed no significant publication bias.
With more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.
2019冠状病毒病（COVID-19）已成为全球大流行疾病和重大公共卫生问题。体外膜肺氧合（ECMO）治疗COVID-19患者的有效性受到质疑。
对需要ECMO的COVID-19患者的死亡率进行荟萃分析。
本分析遵循《系统评价和荟萃分析的首选报告项目2020》（PRISMA），并已在国际前瞻性系统评价注册库注册（注册号CRD42020227414）。采用纽卡斯尔-渥太华量表（NOS）对所有纳入文章进行质量评估。纳入了对更多接受ECMO的COVID-19患者进行研究的文献。采用随机效应模型获得接受ECMO的COVID-19患者的合并死亡率。通过亚组分析和敏感性分析调查异质性来源。
我们识别出18篇文章，共1494例接受ECMO的COVID-19患者。质量评估得分在NOS上为5至8分。大多数患者接受静脉-静脉ECMO（93.7%）。根据随机效应合并估计，总体死亡率估计为0.31[95%置信区间（CI）：0.24 - 0.39；I² = 84.8%]。不同地区组（33.0%、55.0%、37.0%、18.0%，P < 0.001）、机构类型组（28.0%、34.0%，P < 0.001）、样本量组（37.0%、31.0%，P < 0.001）和NOS分组（39.0%、19.0%，P < 0.001）的死亡率存在显著差异。然而，基于地区、机构类型和样本量的亚组分析以及敏感性分析均未识别出异质性来源。漏斗图显示无明显不对称，Egger检验（P = 0.95）和Begg检验（P = 0.14）也未显示出显著的发表偏倚。
通过更多的资源评估和风险效益分析，我们的数据表明ECMO可能是治疗COVID-19患者的一种可行且有效的方法。
