Extracorporeal Membrane Oxygenation (ECMO) Dependent Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis

Dhan B Shrestha; Yub Raj Sedhai; Pravash Budhathoki; Suman Gaire; Prarthana Subedi; Swojay Maharjan; Mengdan Yuan; Ankush Asija; Waqas Memon

doi:10.7759/cureus.25696

Extracorporeal Membrane Oxygenation (ECMO) Dependent Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis

Cureus. 2022 Jun 6;14(6):e25696. doi: 10.7759/cureus.25696. eCollection 2022 Jun.

Authors

Dhan B Shrestha¹, Yub Raj Sedhai², Pravash Budhathoki³, Suman Gaire⁴, Prarthana Subedi⁵, Swojay Maharjan⁵, Mengdan Yuan⁶, Ankush Asija⁷, Waqas Memon²

Affiliations

¹ Department of Medicine, Mount Sinai Hospital, Chicago, USA.
² Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA.
³ Department of Internal Medicine, BronxCare Health System, Bronx, USA.
⁴ Department of Emergency Medicine, Palpa District Hospital, Palpa, NPL.
⁵ Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL.
⁶ Internal Medicine, University of Michigan, Ann Arbor, USA.
⁷ Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, USA.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a newer method for managing severe acute respiratory distress syndrome (ARDS) and ARDS refractory to conventional management. However, its current role in the management of ARDS is not clear. Therefore, we conducted this meta-analysis to compare the mortality rates of ECMO over conventional management in ARDS.

Methods: PubMed, PubMed Central, Embase, and Scopus were searched using appropriate keywords. We selected studies in adults with ARDS that compared the outcomes of patients treated with ECMO vs. conventional management. Cochrane Risk of Bias (RoB) 2.0 and the JBI (Joanna Briggs Institute) quality assessment tools were used for assessing the risk of bias in RCTs and observational studies, respectively. The I² statistic was used to evaluate heterogeneity, and quantitative synthesis was performed using fixed or random effects to pool studies based on heterogeneities. Meta-analysis was conducted using Revman 5.4.

Result: Twelve studies were included in this meta-analysis. As compared to the conventional management (mechanical ventilation: MV), patients treated with ECMO had lower odds of 30-days mortality (OR, 0.56; 95% CI, 0.37 to 0.84) and 90 days mortality (OR, 0.59; 95% CI, 0.41 to 0.85). However, there was no significant difference between in-hospital mortality (OR, 0.75; 95% CI, 0.40 to 1.41) and intensive care unit (ICU) mortality (OR, 1.00; 95% CI, 0.36 to 2.79). Similarly, length of hospital stays (LOS) (MD, 3.92; 95% CI, -6.26 to 14.11) did not show statistically significant differences across the two groups. However, the average ICU stay (ICU LOS) was 7.28 days longer in the ECMO group compared with the MV group (MD, 7.28; 95% CI, 2.55 to 12.02).

Conclusion: Twenty-eight days and 90-days mortality were decreased in patients managed with ECMO compared with the MV group. Also, ICU LOS was found to be longer in the ECMO group. Furthermore, no statistical difference was found between the two groups for in-hospital mortality and hospital LOS.

Keywords: ards; ecmo; mechanical ventilation; meta-analysis; systematic reviews.

Publication types

Review