Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review.

Kim, Jun Hyun; Pieri, Marina; Landoni, Giovanni; Scandroglio, Anna Mara; Calabrò, Maria Grazia; Fominskiy, Evgeny; Lembo, Rosalba; Heo, Min Hee; Zangrillo, Alberto

BACKGROUND Venovenous extracorporeal membrane oxygenation (VV ECMO) has gained popularity for the treatment of refractory respiratory failure during and after the 2009 influenza pandemic, and still represents a precious therapeutic resource for severe novel coronavirus 2019 infection. However, most of the published studies are small case series, and only two randomized trials exist in literature. AIM Aim of this systematic review is to describe trends in VV ECMO treatment outcomes according to large studies only. METHODS We searched and included studies with more than 100 VV ECMO cases dated up to August 1st, 2019. RESULTS Thirty-three studies published in the period 2011-2019 met inclusion criteria, for a total of 12,860 patients (age 46.3 ± 17.4 years). ARDS was mainly by pneumonia, in 3126 (37%) cases; further 401(7%) patients had H1N1 Influenza A infection. Cannulation-related complications occurred in 502 (7%) cases. Weighted mean (95% confidence interval) of VV ECMO duration was 8.9 (8.7-9.1) days, and ICU stay was 23.6 (22.4-24.8) days. Mortality at the longest follow up available was 40%. Data collection in 70% of the studies had a duration of >5 years. CONCLUSION This study reveals the characteristics of large case VV ECMO studies.