A systematic review and meta-analysis comparing the clinical characteristics and outcomes of COVID-19 and influenza patients on ECMO

Woon Hean Chong, Biplab K Saha, Boris I Medarov, Woon Hean Chong, Biplab K Saha, Boris I Medarov

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a valuable rescue therapy to treat refractory hypoxemia caused by influenza. The present meta-analysis aimed to compare the clinical characteristics and outcomes of ECMO between COVID-19 and influenza.

Methods: We searched the PubMed, Cochrane Library, SCOPUS, and Web of Science databases from inception to May 1, 2021. The included studies compared the clinical characteristics and outcomes of ECMO between adults with COVID-19 and those with influenza.

Results: The study included four retrospective cohorts involving a total of 129 patients with COVID-19 and 140 with influenza who were treated using ECMO. Clinical characteristics were similar between the COVID-19 and influenza groups, including body mass index (BMI), diabetes mellitus, hypertension, and immunocompromised status. A higher proportion of patients with COVID-19 on ECMO were male (75.9% vs. 62.9%; P = 0.04). There was no difference between the groups in terms of illness severity based on sequential organ failure assessment (SOFA) score or serum pH. Patients with COVID-19 had a longer mean duration of mechanical ventilation before ECMO (6.63 vs. 3.38 days; P < 0.01). The pooled mortality rate was 43.8%. The mean ECMO duration (14.13 vs. 12.55 days; P = 0.25) and mortality rate (42.6% vs. 45.0%; P = 0.99) were comparable between the groups.

Conclusion: Clinical characteristics, ECMO duration, and mortality were comparable between patients with COVID-19 and those with influenza who required ECMO to treat refractory hypoxemia. The duration of mechanical ventilation before ECMO did not influence outcomes. Patients with COVID-19 benefit from ECMO salvage therapy similarly to those with influenza.

Keywords: COVID-19; ECLS; ECMO; Influenza; SARS-CoV-2.

Conflict of interest statement

Conflict of Interest The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Copyright © 2021 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection.
Fig. 2
Fig. 2
Forrest plot of patients with COVID-19 and those with influenza requiring ECMO support. Clinical characteristics of age, BMI, SOFA score, days from mechanical ventilation to ECMO initiation, and outcome of ECMO duration were assessed. Standard mean differences were calculated by inverse variance statistical method with a random-effects model. Abbreviations: BMI: body mass index; CI, confidence intervals; df, degree of freedom; ECMO, extracorporeal membrane oxygenation; IV, inverse variance; SD, standard deviation; SOFA, sequential organ failure assessment.
Fig. 3
Fig. 3
Forrest plot of patients with COVID-19 or influenza requiring ECMO support. Clinical characteristics of male sex, diabetes mellitus, hypertension, immunocompromised status, and outcome of mortality were assessed. The odds ratio was calculated using the Mantel–Haenszel method with a random-effects model. Abbreviations: CI, confidence intervals; df, degree of freedom; DM, diabetes mellitus; ECMO, extracorporeal membrane oxygenation; HTN, hypertension; M − H, Mantel–Haenszel.
Fig. 4
Fig. 4
Funnel plot for primary outcome of mortality.

References

    1. Alshahrani M.S., Sindi A., Alshamsi F., Al-Omari A., El Tahan M., Alahmadi B., et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018 Dec;8(1):3.
    1. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Davies A., Jones D., Bailey M., Beca J., Bellomo R., et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. J Am Med Assoc. 2009 Nov 4;302(17):1888–1895.
    1. Patroniti N., Zangrillo A., Pappalardo F., Peris A., Cianchi G., Braschi A., et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011 Sep;37(9):1447–1457.
    1. Pham T., Combes A., Rozé H., Chevret S., Mercat A., Roch A., et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)–induced acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013 Feb 1;187(3):276–285.
    1. Munshi L., Walkey A., Goligher E., Pham T., Uleryk E.M., Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med. 2019 Feb;7(2):163–172.
    1. Tang X., Du R.-H., Wang R., Cao T.-Z., Guan L.-L., Yang C.-Q., et al. Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1. Chest. 2020 Jul;158(1):195–205.
    1. Ludwig M., Jacob J., Basedow F., Andersohn F., Walker J. Clinical outcomes and characteristics of patients hospitalized for Influenza or COVID-19 in Germany. Int J Infect Dis. 2021 Feb;103:316–322.
    1. Piroth L., Cottenet J., Mariet A.-S., Bonniaud P., Blot M., Tubert-Bitter P., et al. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. Lancet Respir Med. 2021 Mar;9(3):251–259.
    1. Xie Y., Bowe B., Maddukuri G., Al-Aly Z. Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study. BMJ. 2020 Dec 15:m4677.
    1. Gjurašin B., Santini M., Krajinović V., Papić N., Atelj A., Kotarski V., et al. A retrospective comparison between influenza and COVID-19-associated ARDS in a Croatian tertiary care center. Wien Klin Wochenschr. 2020 Nov 20 [Internet]. [cited 2021 Mar 6]; Available from:
    1. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010 Sep;25(9):603–605.
    1. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188.
    1. Higgins J.P.T., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ. 2003 Sep 6;327(7414):557–560.
    1. Luyt C.-E., Sahnoun T., Gautier M., Vidal P., Burrel S., Pineton de Chambrun M., et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Ann Intensive Care. 2020 Dec;10(1):158.
    1. Shekar K., Badulak J., Peek G., Boeken U., Dalton H.J., Arora L., et al. Extracorporeal life support organization coronavirus disease 2019 interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers. Am Soc Artif Intern Organs J. 2020 Jul;66(7):707–721.
    1. USA Extracorporeal Life Support Organization - ECMO and ECLS ELSO guidelines for cardiopulmonary extracorporeal life support extracorporeal life support organization. Resour Guidel. 2017 Aug 1 [Internet]. Available from:
    1. Posluszny J., Rycus P.T., Bartlett R.H., Engoren M., Haft J.W., Lynch W.R., et al. Outcome of adult respiratory failure patients receiving prolonged (≥14 Days) ECMO. Ann Surg. 2016 Mar;263(3):573–581.
    1. Chang C.-H., Chen H.-C., Caffrey J.L., Hsu J., Lin J.-W., Lai M.-S., et al. Survival analysis after extracorporeal membrane oxygenation in critically ill adults: a nationwide cohort study. Circulation. 2016 Jun 14;133(24):2423–2433.
    1. Barbaro R.P., Odetola F.O., Kidwell K.M., Paden M.L., Bartlett R.H., Davis M.M., et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015 Apr 15;191(8):894–901.
    1. Barbaro R.P., MacLaren G., Boonstra P.S., Iwashyna T.J., Slutsky A.S., Fan E., et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020 Oct;396(10257):1071–1078.
    1. Gattinoni L., Chiumello D., Caironi P., Busana M., Romitti F., Brazzi L., et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020 Jun;46(6):1099–1102.
    1. Gattinoni L., Coppola S., Cressoni M., Busana M., Rossi S., Chiumello D. COVID-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020 May 15;201(10):1299–1300.
    1. Tobin M.J., Laghi F., Jubran A. Why COVID-19 silent hypoxemia is baffling to physicians. Am J Respir Crit Care Med. 2020 Aug 1;202(3):356–360.
    1. Jounieaux V., Rodenstein D.O., Mahjoub Y. On happy hypoxia and on sadly ignored “acute vascular distress syndrome” in patients with COVID-19. Am J Respir Crit Care Med. 2020 Dec 1;202(11):1598–1599.
    1. Pan C., Chen L., Lu C., Zhang W., Xia J.-A., Sklar M.C., et al. Lung recruitability in COVID-19–associated acute respiratory distress syndrome: a single-center observational study. Am J Respir Crit Care Med. 2020 May 15;201(10):1294–1297.
    1. Bemtgen X., Zotzmann V., Benk C., Rilinger J., Steiner K., Asmussen A., et al. Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19. J Thromb Thrombolysis. 2021 Feb;51(2):301–307.
    1. Yusuff H., Zochios V., Brodie D. Thrombosis and coagulopathy in COVID-19 patients requiring extracorporeal membrane oxygenation. ASAIO J. 2020 Aug;66(8):844–846. Am Soc Artif Intern Organs 1992.
    1. Charlton M., Dashey S., Stubbs A., Lai F.Y., Bird P.W., Badhwar V., et al. Comparing SARS-CoV-2 and influenza A(H1N1)pdm09-infected patients requiring ECMO – a single-centre, retrospective observational cohort experience. J Infect. 2021;82(4):84–123. S0163445320306988.
    1. Cousin N., Bourel C., Carpentier D., Goutay J., Mugnier A., Labreuche J., et al. SARS-CoV-2 versus influenza associated acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation support. ASAIO J. 2020 Oct 13 [Internet]. [cited 2021 Feb 27];Publish Ahead of Print. Available from:
    1. Jäckel M., Rilinger J., Lang C.N., Zotzmann V., Kaier K., Stachon P., et al. Outcome of acute respiratory distress syndrome requiring extracorporeal membrane oxygenation in Covid-19 or influenza: a single-center registry study. Artif Organs. 2020 Dec 18 doi: 10.1111/aor.13865.

Source: PubMed

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