ECMO y mortalidad de pacientes con coronavirus en UCI: revision sistemática

Abstract

Introduction: Coronavirus infection can cause SARS and MERS, with serious oxygenation disorders and a requirement for ICU management and rescue therapies such as ECMO. Objective: To establish the mortality of patients with SARS or MERS undergoing ECMO in the intensive care unit. Methods: Systematic review by searching 4 databases (Medline, Embase, Lilacs, and Cochrane) and manual searching. RCT, CCT, and analytical studies were eligible. Two reviewers independently screened, extracted information from the evidence, and assessed methodological quality using the Newcastle-Ottawa scale. The body of evidence was assessed using the GRADE methodology. Results: 458 references were identified; one met eligibility criteria, corresponding to a retrospective cohort, historical control, with low risk of bias and quality of the evidence, which included 35 patients (17 ECMO / 18 control), with median ages of 45.5 and 50 years respectively, a higher percentage of men in both groups and a median in APACHE II scale of 27.8 and 31. ECMO was significantly associated with lower mortality at 90 days (p = 0.02) and longer median ICU stay (22.5 vs. 7 days; p = 0.001). Two major bleeds and one pneumothorax were reported in the ECMO group. Conclusion: The evidence supporting the impact of ECMO on the mortality of patients with MERS-CoV is limited to one study with a low level of evidence; ECMO use was significantly associated with lower 90-day mortality in patients with MERS-CoV infection and refractory hypoxia.