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

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.

In conclusion, these authors recommend ECMO use in COVID-19 but with caution and in compliance with current guidelines. While evidence advocating ECMO use in COVID-19 is not substantial, ongoing studies may provide new insight in ECMO use in COVID-19 patients in critical cases. To ensure optimal patient care, a case-by-case approach should be implemented, with risk-benefit analysis conducted for each patient