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Extracorporeal membrane oxygenation (ECMO) in patients with severe COVID-19 adult respiratory distress syndrome: a systematic review and meta-analysis
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  • Hany Elsayed,
  • Aly Hassaballa,
  • Taha Ahmed,
  • Mohammed Gumaa,
  • Hazem Sharkawy
Hany Elsayed
Ain Shams University Faculty of Medicine
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Aly Hassaballa
Ain Shams University Faculty of Medicine
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Taha Ahmed
Ain Shams University Faculty of Medicine
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Mohammed Gumaa
Ain Shams University Faculty of Medicine
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Hazem Sharkawy
Ain Shams University Faculty of Medicine
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Abstract

Background COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for COVID-associated ARDS to study its outcome. Materials and Methods CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from inception to May 28, 2020. Studies reporting five or more patients with COVID 19 infection treated venovenous with ECMO were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. The validity of all the included observational studies was appraised with the Newcastle Ottawa scale. Meta-regression and publication bias were tested. This trial was registered with PROSPERO under registration number CRD42020183861 Results From 1647 initial citations, 34 full text articles were analysed and 12 studies were selected, including 194 patients with confirmed COVID 19 infection requiring ICU admission and venovenous ECMO treatment. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.49 (95% confidence interval 0.259 to 0.721; I2 = 94%). Subgroup analysis according to country of origin showed persistent heterogeneity only in the 7 Chinese studies with pooled estimate mortality risk ratio of 0.66 (I2 = 87%) (95% CI = 0.39-0.93), while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.41 (95% CI 0.28-0.53) with homogeneity (p=0.67) similar to France with a pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86).

Peer review status:IN REVISION

06 Sep 2020Submitted to Journal of Cardiac Surgery
08 Sep 2020Assigned to Editor
08 Sep 2020Submission Checks Completed
14 Sep 2020Reviewer(s) Assigned
14 Sep 2020Review(s) Completed, Editorial Evaluation Pending
14 Sep 2020Editorial Decision: Revise Major
27 Sep 20201st Revision Received
28 Sep 2020Assigned to Editor
28 Sep 2020Submission Checks Completed