Yub Raj Sedhai, MD
MD
Virginia Commonwealth University, United States
Disclosure information not submitted.
Dhan Shrestha, MD
Resident Physician
Mount Sinai Hospital
Chicago, Illinois, United States
Disclosure information not submitted.
Pravash Budhathoki, MD
Resident Physician
BronxCare Health System, Bronx, NY, USA
Bronx, New York, United States
Disclosure information not submitted.
Suman Gaire, MBBS
Medical doctor
Palpa Hospital, Palpa, Nepal
Palpa, Lumbini, Nepal
Disclosure information not submitted.
Waqas Memon, MD
Nephrologist
VCU School of Medicine, Richmond, VA, Virginia, United States
Disclosure information not submitted.
Ankush Asija, MD
Hospitalist
West Virginia University, Morgantown, WV 26506, Virginia, United States
Disclosure information not submitted.
Swojay Maharjan, MBBS
Medical student
Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
Kathmandu, Bagmati, Nepal
Disclosure information not submitted.
Prarthana Subedi, MBBS
Medical student
Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
Kathmandu, Bagmati, Nepal
Disclosure information not submitted.
Mengdan Yuan
Data analyst
University of Michigan, Michigan, United States
Disclosure information not submitted.
Title: Extracorporeal Membrane Oxygenation (ECMO) in ARDS: A Systematic Review and Meta-Analysis
Introduction: We conducted this systematic review and meta-analysis to compare the effects of ECMO in mortality rates, length of hospital stay, and adverse clinical outcomes in patients with ARDS to that of conventional management.
Methods: We searched PubMed, PubMed Central, Embase, and Scopus databases using an appropriate search strategy. After a thorough screening, studies that compared the effects of ECMO to conventional management in adult patients with ARDS were included. Quantitative synthesis was done via Revman 5.4 software. The data was evaluated via a fixed or random-effects model according to heterogeneity. Statistical heterogeneity was assessed using the I2 statistic. The mortality outcome was reported with Odds ratio, and the length of hospital stay was reported using mean difference and 95 % CI and p-value. Sensitivity analysis was conducted by excluding the RCTs to see if they had different effects.
Results: Among 12357 studies screened, eleven studies meet the criteria (including two RCTs), and were included in quantitative analysis. ECMO did not show significant reduction in-hospital mortality (OR, 0.75; CI, 0.40-1.41; I2 = 66% ) or ICU mortality (OR, 1.00; CI, 0.36-2.79; I2 = 68%) as compared to conventional management for ARDS using random-effect model. However , the patients treated with ECMO had lower odds of 30 days mortality (OR, 0.56; CI, 0.37-0.84; I2 = 0%) and 90 days mortality(OR, 0.59; CI, 0.43-0.80; I2 = 0%) than the patients treated with conventional treatment. The average length of hospital stay was similar in both groups (MD, 7.17; CI, -2.24 to 16.58; I2 = 73%). However, the patients treated with ECMO stayed in the ICU longer by an average of 7.28 days as compared to conventional treatment (MD, 7.28; CI, 2.55-12.02; I2 = 69%).
Conclusion: ECMO improved 30 days mortality and 90 days mortality outcomes in patients with ARDS. Thus, ECMO offers a mortality benefit in ARDS refractory to conventional management. Wider availability and use of ECMO can improve clinical outcomes in ARDS.