Title : Outcomes of ecmo in patients with COVID-19 versus influenza: A literature review
Abstract:
Extracorporeal membrane oxygenation (ECMO) has been increasingly utilized as a rescue therapy to treat refractory acute respiratory distress syndrome (ARDS) in viral pneumonia. However, much less is known about the benefit of managing COVID-19 associated ARDS through ECMO compared to that of influenza, such as the influenza A H1N1 virus. This review aims to evaluate the mortality and complications of ECMO therapy between patients with COVID-19 and influenza. PubMed, Embase, and Cochrane Library were searched and seven articles were selected. Five of the studies found no difference in mortality rate while two studies revealed COVID-19 patients on ECMO had statistically significant higher mortality than influenza patients. Additionally, COVID-19 patients appeared to experience longer ECMO duration and length of stay, as well as higher incidence of bleeding, thromboembolism, and infection. One study suggested that independent risk factors for mortality, such as older age and time before ECMO initiation, explained the higher crude mortality rate in COVID-19 patients. Thus, outcomes may depend more strongly on patient selection rather than viral etiology. Overall, current evidence supports ECMO utilization in COVID-19 patients with refractory ARDS. Nonetheless, individual patient demographics and independent risk factors for complications need to be carefully considered prior to initiating this scarce resource. Further research on morbidity and health-related quality of life in patients who survived until discharge are needed to better understand the lasting effects of this treatment modality
