Evidence before this study
ECMO appeared to benefit during the influenza A (H1N1) pandemic in 2009 and the middle east respiratory syndrome (MERS) starting in 2012. Patients with refractory ARDS showed that ECMO should be used as a rescue therapy because it is associated with lower mortality when compared to conventional mechanical ventilation. The role of ECMO in the management of ARDS related to the current COVID-19 pandemic remains debatable. The initial reports of using venovenous ECMO with COVID- 19 patients suffering from intractable hypoxemia observed a high mortality rate and recommended using ECMO with caution in the current pandemic. CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from inception to May 28, 2020, for terms related to COVID 19 and ECMO use with no language restrictions. The word search used was (COVID OR SARS COV2 OR pandemic) AND (ARDS) OR (acute respiratory distress syndrome) OR (acute lung injury) OR (respiratory failure) OR (respiratory insufficiency) OR (ECMO) OR (extracorporeal membrane oxygenation). Studies were included if they provided numerical or formal qualitative data on final ECMO outcomes in the current COVID 19 pandemic. None of the included studies involve prospective randomized analyses; and therefore, all the included studies were of low or moderate quality according to the Newcastle-Ottawa scale. However, because of the unique challenges and unprecedented timeline of this pandemic, it is not surprising that a prospective randomized analysis has not been performed assessing the role of ECMO in supporting patients with COVID-19. In fact, the investigators publishing the various studies reported in this systematic review are to be congratulated for their efforts to conduct this research during these challenging times.