Evidence map›Paper›PMID 34127027›Full record

SynthesisCritical care (London, England)2021

Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis.

Kollengode Ramanathan, Kiran Shekar, Ryan Ruiyang Ling, Ryan P Barbaro, Suei Nee Wong, Chuen Seng Tan, Bram Rochwerg, Shannon M Fernando, Shinhiro Takeda, Graeme MacLaren and 2 more

Erratum issuedOpen access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 149 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
149citing papers in PubMed, 10 pooled it
21.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

149 citing papers in PubMed, 10 syntheses or guidelines pooled it, 284 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Extracorporeal membrane oxygenation for critically ill adults.The Cochrane database of systematic reviews · 2023
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Article
  12. Queensland adult ECMO retrieval service: A description of the service and analysis of outcomes.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026
    Article
  13. Article
  14. Review
  15. Article
  16. ECMO-weaning facilitated by neurally adjusted ventilatory assist (NAVA): a case for principal clarification.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2025
    Article
  17. Review
  18. Article
  19. Article
  20. Article

89 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 8 institutions in 5 countries.

Kollengode Ramanathan *Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. ram_ramanathan@nuhs.edu.sg.ORCID http://orcid.org/0000-0003-1822-9455
Kiran Shekar *Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia.
Ryan Ruiyang LingYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Ryan P BarbaroDivision of Paediatric Critical Care Medicine, University of Michigan, Ann Arbor, USA.
Suei Nee WongYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Chuen Seng TanYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Bram RochwergDepartment of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Shinhiro TakedaJapan ECMOnet for COVID-19 & President, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan.
Graeme MacLarenYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Eddy FanInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Daniel BrodieDepartment of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
National University of Singapore · SGBond University · AUImpact · CANewYork–Presbyterian Hospital · USNoguchi Hospital · JPUniversity of Michigan · USUniversity of Ottawa · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research.

methodsWe searched MEDLINE, Embase, Cochrane and Scopus databases from 1 December 2019 to 10 January 2021 for observational studies or randomised clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and meta-regression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO.

resultsWe included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI 32.3-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI 30.7-40.7%, high certainty). Meta-regression found that age and ECMO duration were associated with increased mortality. Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI 50.5-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common.

conclusionThe majority of patients received venovenous ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1% during the first year of the pandemic, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS. PROSPERO CRD42020192627.

Indexed as

AdultAgedAge FactorsCOVID-19Critical IllnessExtracorporeal Membrane OxygenationFemaleHumansMaleMiddle AgedPositive-Pressure RespirationRespiratory Distress SyndromeRisk AssessmentAcute respiratory distress syndromeCOVID-19Extracorporeal membrane oxygenationSARS-CoV-2

Identifiers

PMID34127027
PMCPMC8201440
OpenAlexW3155073785

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.