The application of extracorporeal membrane oxygenation in patients with COVID-19: a systematic review and meta-analyses of cohort studies_Chinese Journal of Evidence-Based Medicine

Authors：

SU Yi ¹ , MA Mingyuan ¹ , GUO Qianqian ² ,  GUO Liheng ³

1. Department of Intensive Unit Care, Foshan Hospital of TCM Affiliated with Guangzhou University of Chinese Medicine, Foshan 528000, P.R.China;
2. Department of Breast, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong 510000, P.R.China;
3. Department of Intensive Unit Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, P.R.China;

Corresponding author：

GUO Liheng, Email: lihengguo@gzucm.edu.cn

Keywords：

Coronavirus disease 2019; Extracorporeal membrane oxygenation; ARDS; Conventional therapy; Meta-analysis

DOI：

10.7507/1672-2531.202101122

Video：

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Objective To systematically review the application of extracorporeal membrane oxygenation (ECMO) in patients with coronavirus disease 2019 (COVID-19).Methods PubMed, The Cochrane Library, EMbase, CBM, WanFang Data and CNKI databases were searched for studies on ECMO for COVID-19 from December 1^st, 2019 to December 31^st, 2020. Two researchers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.Results A total of 24 studies were included, involving 1 576 acute respiratory distress syndrome (ARDS) patients with COVID-19. The overall mortality of patients was 27.3% (430/1 576). The rate of ECMO treatment was 4.68% (379/1576), and the survival rate was 69.4% (263/379). The mean duration of mechanical ventilation prior to ECMO treatment for ARDS patients ranged from 2.07±0.40 to 15.89±13.0 days, compared with 1.64±0.78 days and 29.9±3.60 days for ECMO treatment. Of the 11 studies included in the meta-analysis, 84.0% (405/482) patients with ARDS received conventional treatment with COVID-19, and 16.0% (77/482) received ECMO treatment on the basis of conventional treatment with ARDS. Results of meta-analysis showed that there was statistically significant difference in the survival rate of ARDS patients with COVID-19 treated with conventional therapy combined with ECMO or with conventional therapy alone (RR=1.27, 95%CI 1.00 to 1.62, P=0.05).Conclusions This study suggests that the survival rate of COVID-19 patients after ECMO treatment has a tendency to improve. Due to the limitation of quantity and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.

Citation： SU Yi, MA Mingyuan, GUO Qianqian, GUO Liheng. The application of extracorporeal membrane oxygenation in patients with COVID-19: a systematic review and meta-analyses of cohort studies. Chinese Journal of Evidence-Based Medicine, 2021, 21(7): 803-809. doi: 10.7507/1672-2531.202101122 Copy

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2.	Zheng Z, Ma H, Zhang X, et al. Enhanced glycolytic metabolism contributes to cardiac dysfunction in polymicrobial sepsis. J Infect Dis, 2017, 215(9): 1396-1406.
3.	Li H, Zhou Y, Zhang M, et al. Updated approaches against SARS-CoV-2. Antimicrob Agents Chemother, 2020, 64(6): e00483-420.
4.	Pravda NS, Pravda MS, Kornowski R, et al. Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic. Future Cardiol, 2020, 16(6): 543-546.
5.	Prekker ME, Brunsvold ME, Bohman JK, et al. Regional planning for extracorporeal membrane oxygenation allocation during coronavirus disease 2019. Chest, 2020, 158(2): 603-607.
6.	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
7.	Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, 395(10223): 507-513.
8.	Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 2020, 8(5): 475-481.
9.	Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020, 395(10229): 1054-1062.
10.	Ruan Q, Yang K, Wang W, et al. Correction to: Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med, 2020, 46(6): 1294-1297.
11.	Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med, 2020, 180(7): 934-943.
12.	Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med, 2020, 382(24): 2327-2336.
13.	金爱华, 贾琳, 阎本永, 等. 北京地区 19 例重症和危重症 COVID-19 患者临床分析. 中华实验和临床病毒学杂志, 2020, 34(3): 225-230.
14.	Barrasa H, Rello J, Tejada S, et al. SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria. Anaesth Crit Care Pain Med, 2020, 39(5): 553-561.
15.	Yang X, Cai S, Luo Y, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019-induced acute respiratory distress syndrome: a multicenter descriptive study. Crit Care Med, 2020, 48(9): 1289-1295.
16.	Alnababteh M, Hashmi MD, Vedantam K, et al. Extracorporeal membrane oxygenation for COVID-19 induced hypoxia: single-center study. Perfusion, 2020: 267659120963885.
17.	Sromicki J, Schmiady M, Maisano F, et al. ECMO therapy in COVID-19: an experience from Zurich. J Card Surg, 2021, 36(5): 1707-1712.
18.	Mustafa AK, Alexander PJ, Joshi DJ, et al. Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure. JAMA Surg, 2020, 155(10): 990-992.
19.	Le Breton C, Besset S, Freita-Ramos S, et al. Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome. J Crit Care, 2020, 60: 10-12.
20.	Huette P, Beyls C, Guilbart M, et al. Extracorporeal membrane oxygenation for respiratory failure in COVID-19 patients: outcome and time-course of clinical and biological parameters. Can J Anaesth, 2020, 67(10): 1486-1488.
21.	Schmidt M, Hajage D, Lebreton G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med, 2020, 8(11): 1121-1131.
22.	Yang Y, Rali AS, Inchaustegui C, et al. Extracorporeal membrane oxygenation in coronavirus disease 2019-associated acute respiratory distress syndrome: an initial US experience at a high-volume centre. Card Fail Rev, 2020, 6: e17.
23.	Jacobs JP, Stammers AH, St Louis J, et al. Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise in coronavirus disease 2019: experience with 32 patients. ASAIO J, 2020, 66(7): 722-730.
24.	Riera J, Argudo E, Martínez-Martínez M, et al. Extracorporeal membrane oxygenation retrieval in coronavirus disease 2019: a case-series of 19 patients supported at a high-volume extracorporeal membrane oxygenation center. Crit Care Explor, 2020, 2(10): e0228.
25.	Kon ZN, Smith DE, Chang SH, et al. Extracorporeal membrane oxygenation support in severe COVID-19. Ann Thorac Surg, 2021, 111(2): 537-543.
26.	Zayat R, Kalverkamp S, Grottke O, et al. Role of extracorporeal membrane oxygenation in critically Ill COVID-19 patients and predictors of mortality. Artif Organs, 2020. DOI: 10.1111/aor.13873.
27.	Akhtar W, Olusanya O, Baladia MM, et al. SARS-CoV-2 and ECMO: early results and experience. Indian J Thorac Cardiovasc Surg, 2020, 37(1): 1-8.
28.	Guihaire J, Owyang CG, Madhok J, et al. Specific considerations for venovenous extracorporeal membrane oxygenation during coronavirus disease 2019 pandemic. ASAIO J, 2020, 66(10): 1069-1072.
29.	汪璐芸, 陈铿铨, 陈鹏, 等. 体外膜肺氧合在救治新型冠状病毒肺炎相关严重急性呼吸窘迫综合征中的应用及预后分析. 内科急危重症杂志, 2020, 26(6): 458-463.
30.	Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol, 2020, 92(4): 401-402.
31.	Morse JS, Lalonde T, Xu S, et al. Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV. Chembiochem, 2020, 21(5): 730-738.
32.	Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res, 2020, 30(3): 269-271.
33.	Lim JKB, Qadri SK, Toh TSW, et al. Extracorporeal membrane oxygenation for severe respiratory failure during respiratory epidemics and pandemics: a narrative review. Ann Acad Med Singap, 2020, 49(4): 199-214.
34.	Pelekhaty SL, Pajoumand M, Omanwa KS, et al. Oxandrolone in patients on venovenous extracorporeal membrane oxygenation: a case series. Nutr Clin Pract, 2020, 35(3): 514-521.
35.	Ñamendys-Silva SA. ECMO for ARDS due to COVID-19. Heart Lung, 2020, 49(4): 348-349.
36.	Alhazzani W, Møller MH, Arabi YM, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med, 2020, 46(5): 854-887.
37.	张伟, 潘纯, 宋青. 危重症新型冠状病毒肺炎肺损伤治疗过程中应关注的问题. 解放军医学杂志, 2020, 45(3): 236-240.
38.	李斌, 刘爱军, 杨明, 等. 新型冠状病毒肺炎疫情期间心血管疾病管理与诊治策略. 心肺血管病杂志, 2020, 39(2): 120-126.
39.	Ramanathan K, Antognini D, Combes A, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med, 2020, 8(5): 518-526.
40.	Zhang C, Huang S, Zheng F, et al. Controversial treatments: an updated understanding of the coronavirus disease 2019. J Med Virol, 2020, 92(9): 1441-1448.
41.	Goh KJ, Choong MC, Cheong EH, et al. Rapid progression to acute respiratory distress syndrome: review of current understanding of critical illness from COVID-19 infection. Ann Acad Med Singap, 2020, 49(3): 108-118.
42.	Borges do Nascimento IJ, Cacic N, Abdulazeem HM, et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med, 2020, 9(4): 941.
43.	Haiduc AA, Alom S, Melamed N, et al. Role of extracorporeal membrane oxygenation in COVID-19: a systematic review. J Card Surg, 2020, 35(10): 2679-2687.
44.	Hu BS, -Z Hu M, Jiang LX, et al. Extracorporeal membrane oxygenation (ECMO) in patients with COVID-19: a rapid systematic review of case studies. Eur Rev Med Pharmacol Sci, 2020, 24(22): 11945-11952.
45.	Melhuish TM, Vlok R, Thang C, et al. Outcomes of extracorporeal membrane oxygenation support for patients with COVID-19: a pooled analysis of 331 cases. Am J Emerg Med, 2021, 39: 245-246.
46.	Li X, Guo Z, Li B, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019 in Shanghai, China. ASAIO J, 2020, 66(5): 475-481.
47.	Nakasato GR, Lopes JL, Lopes CT. Predictors of complications associated with extracorporeal membrane oxygenation. Rev Bras Enferm, 2020, 73(2): e20180666.
48.	Li M, Gu SC, Wu XJ, et al. Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease: indications, timing, and implementation. Chin Med J (Engl), 2020, 133(9): 1115-1117.
49.	张春, 司向, 林婷, 等. 危重型新型冠状病毒肺炎患者体外器官支持若干问题的思考与认识. 西安交通大学学报(医学版), 2021, 42(1): 99-102, 127.
50.	Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J, 2015, 36(33): 2246-2256.
51.	马文帅, 郭万刚, 尹姣, 等. ECMO 在新型冠状病毒肺炎危重症患者中应用价值的探讨. 心脏杂志, 2020, 32(2): 202-205.
52.	Hong X, Xiong J, Feng Z, et al. Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19? Int J Infect Dis, 2020, 94: 78-80.
53.	江哲珍, 张祥翰, 宋丹. 1例危重型新型冠状病毒肺炎病人应用体外膜肺氧合救治的护理. 全科护理, 2020, 18(5): 570-572.
54.	任卫红, 沈利汉, 赵妙玲, 等. 12 例新型冠状病毒肺炎危重型患者护理难点及对策. 护理学报, 2020, 27(5): 68-71.
55.	曹皇亮, 廖雅, 刘铃. ECMO 联合 CRRT 救治新冠肺炎患者的护理体会. 齐鲁护理杂志, 2020, 26(6): 16-18.
56.	马晶, 胡芬, 孙慧敏, 等. 运用 ECMO 救治新型冠状病毒(2019-nCoV)感染的重症肺炎患者的护理体会. 医学新知, 2020, 30(1): 74-77.
57.	朱豫, 戴晓婧, 华莎, 等. 3 例危重症型冠状病毒肺炎患者应用体外膜肺氧合联合俯卧位通气的护理. 解放军护理杂志, 2020, 37(4): 90-92.
58.	张浦, 李锦, 李朝阳, 等. 9 例新型冠状病毒肺炎危重型患者行ECMO治疗的护理. 护理学报, 2020, 27(5): 60-63.

1. Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents, 2020, 55(3): 105924.
2. Zheng Z, Ma H, Zhang X, et al. Enhanced glycolytic metabolism contributes to cardiac dysfunction in polymicrobial sepsis. J Infect Dis, 2017, 215(9): 1396-1406.
3. Li H, Zhou Y, Zhang M, et al. Updated approaches against SARS-CoV-2. Antimicrob Agents Chemother, 2020, 64(6): e00483-420.
4. Pravda NS, Pravda MS, Kornowski R, et al. Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic. Future Cardiol, 2020, 16(6): 543-546.
5. Prekker ME, Brunsvold ME, Bohman JK, et al. Regional planning for extracorporeal membrane oxygenation allocation during coronavirus disease 2019. Chest, 2020, 158(2): 603-607.
6. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
7. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, 395(10223): 507-513.
8. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 2020, 8(5): 475-481.
9. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020, 395(10229): 1054-1062.
10. Ruan Q, Yang K, Wang W, et al. Correction to: Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med, 2020, 46(6): 1294-1297.
11. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med, 2020, 180(7): 934-943.
12. Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med, 2020, 382(24): 2327-2336.
13. 金爱华, 贾琳, 阎本永, 等. 北京地区 19 例重症和危重症 COVID-19 患者临床分析. 中华实验和临床病毒学杂志, 2020, 34(3): 225-230.
14. Barrasa H, Rello J, Tejada S, et al. SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria. Anaesth Crit Care Pain Med, 2020, 39(5): 553-561.
15. Yang X, Cai S, Luo Y, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019-induced acute respiratory distress syndrome: a multicenter descriptive study. Crit Care Med, 2020, 48(9): 1289-1295.
16. Alnababteh M, Hashmi MD, Vedantam K, et al. Extracorporeal membrane oxygenation for COVID-19 induced hypoxia: single-center study. Perfusion, 2020: 267659120963885.
17. Sromicki J, Schmiady M, Maisano F, et al. ECMO therapy in COVID-19: an experience from Zurich. J Card Surg, 2021, 36(5): 1707-1712.
18. Mustafa AK, Alexander PJ, Joshi DJ, et al. Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure. JAMA Surg, 2020, 155(10): 990-992.
19. Le Breton C, Besset S, Freita-Ramos S, et al. Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome. J Crit Care, 2020, 60: 10-12.
20. Huette P, Beyls C, Guilbart M, et al. Extracorporeal membrane oxygenation for respiratory failure in COVID-19 patients: outcome and time-course of clinical and biological parameters. Can J Anaesth, 2020, 67(10): 1486-1488.
21. Schmidt M, Hajage D, Lebreton G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med, 2020, 8(11): 1121-1131.
22. Yang Y, Rali AS, Inchaustegui C, et al. Extracorporeal membrane oxygenation in coronavirus disease 2019-associated acute respiratory distress syndrome: an initial US experience at a high-volume centre. Card Fail Rev, 2020, 6: e17.
23. Jacobs JP, Stammers AH, St Louis J, et al. Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise in coronavirus disease 2019: experience with 32 patients. ASAIO J, 2020, 66(7): 722-730.
24. Riera J, Argudo E, Martínez-Martínez M, et al. Extracorporeal membrane oxygenation retrieval in coronavirus disease 2019: a case-series of 19 patients supported at a high-volume extracorporeal membrane oxygenation center. Crit Care Explor, 2020, 2(10): e0228.
25. Kon ZN, Smith DE, Chang SH, et al. Extracorporeal membrane oxygenation support in severe COVID-19. Ann Thorac Surg, 2021, 111(2): 537-543.
26. Zayat R, Kalverkamp S, Grottke O, et al. Role of extracorporeal membrane oxygenation in critically Ill COVID-19 patients and predictors of mortality. Artif Organs, 2020. DOI: 10.1111/aor.13873.
27. Akhtar W, Olusanya O, Baladia MM, et al. SARS-CoV-2 and ECMO: early results and experience. Indian J Thorac Cardiovasc Surg, 2020, 37(1): 1-8.
28. Guihaire J, Owyang CG, Madhok J, et al. Specific considerations for venovenous extracorporeal membrane oxygenation during coronavirus disease 2019 pandemic. ASAIO J, 2020, 66(10): 1069-1072.
29. 汪璐芸, 陈铿铨, 陈鹏, 等. 体外膜肺氧合在救治新型冠状病毒肺炎相关严重急性呼吸窘迫综合征中的应用及预后分析. 内科急危重症杂志, 2020, 26(6): 458-463.
30. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol, 2020, 92(4): 401-402.
31. Morse JS, Lalonde T, Xu S, et al. Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV. Chembiochem, 2020, 21(5): 730-738.
32. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res, 2020, 30(3): 269-271.
33. Lim JKB, Qadri SK, Toh TSW, et al. Extracorporeal membrane oxygenation for severe respiratory failure during respiratory epidemics and pandemics: a narrative review. Ann Acad Med Singap, 2020, 49(4): 199-214.
34. Pelekhaty SL, Pajoumand M, Omanwa KS, et al. Oxandrolone in patients on venovenous extracorporeal membrane oxygenation: a case series. Nutr Clin Pract, 2020, 35(3): 514-521.
35. Ñamendys-Silva SA. ECMO for ARDS due to COVID-19. Heart Lung, 2020, 49(4): 348-349.
36. Alhazzani W, Møller MH, Arabi YM, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med, 2020, 46(5): 854-887.
37. 张伟, 潘纯, 宋青. 危重症新型冠状病毒肺炎肺损伤治疗过程中应关注的问题. 解放军医学杂志, 2020, 45(3): 236-240.
38. 李斌, 刘爱军, 杨明, 等. 新型冠状病毒肺炎疫情期间心血管疾病管理与诊治策略. 心肺血管病杂志, 2020, 39(2): 120-126.
39. Ramanathan K, Antognini D, Combes A, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med, 2020, 8(5): 518-526.
40. Zhang C, Huang S, Zheng F, et al. Controversial treatments: an updated understanding of the coronavirus disease 2019. J Med Virol, 2020, 92(9): 1441-1448.
41. Goh KJ, Choong MC, Cheong EH, et al. Rapid progression to acute respiratory distress syndrome: review of current understanding of critical illness from COVID-19 infection. Ann Acad Med Singap, 2020, 49(3): 108-118.
42. Borges do Nascimento IJ, Cacic N, Abdulazeem HM, et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med, 2020, 9(4): 941.
43. Haiduc AA, Alom S, Melamed N, et al. Role of extracorporeal membrane oxygenation in COVID-19: a systematic review. J Card Surg, 2020, 35(10): 2679-2687.
44. Hu BS, -Z Hu M, Jiang LX, et al. Extracorporeal membrane oxygenation (ECMO) in patients with COVID-19: a rapid systematic review of case studies. Eur Rev Med Pharmacol Sci, 2020, 24(22): 11945-11952.
45. Melhuish TM, Vlok R, Thang C, et al. Outcomes of extracorporeal membrane oxygenation support for patients with COVID-19: a pooled analysis of 331 cases. Am J Emerg Med, 2021, 39: 245-246.
46. Li X, Guo Z, Li B, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019 in Shanghai, China. ASAIO J, 2020, 66(5): 475-481.
47. Nakasato GR, Lopes JL, Lopes CT. Predictors of complications associated with extracorporeal membrane oxygenation. Rev Bras Enferm, 2020, 73(2): e20180666.
48. Li M, Gu SC, Wu XJ, et al. Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease: indications, timing, and implementation. Chin Med J (Engl), 2020, 133(9): 1115-1117.
49. 张春, 司向, 林婷, 等. 危重型新型冠状病毒肺炎患者体外器官支持若干问题的思考与认识. 西安交通大学学报(医学版), 2021, 42(1): 99-102, 127.
50. Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J, 2015, 36(33): 2246-2256.
51. 马文帅, 郭万刚, 尹姣, 等. ECMO 在新型冠状病毒肺炎危重症患者中应用价值的探讨. 心脏杂志, 2020, 32(2): 202-205.
52. Hong X, Xiong J, Feng Z, et al. Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19? Int J Infect Dis, 2020, 94: 78-80.
53. 江哲珍, 张祥翰, 宋丹. 1例危重型新型冠状病毒肺炎病人应用体外膜肺氧合救治的护理. 全科护理, 2020, 18(5): 570-572.
54. 任卫红, 沈利汉, 赵妙玲, 等. 12 例新型冠状病毒肺炎危重型患者护理难点及对策. 护理学报, 2020, 27(5): 68-71.
55. 曹皇亮, 廖雅, 刘铃. ECMO 联合 CRRT 救治新冠肺炎患者的护理体会. 齐鲁护理杂志, 2020, 26(6): 16-18.
56. 马晶, 胡芬, 孙慧敏, 等. 运用 ECMO 救治新型冠状病毒(2019-nCoV)感染的重症肺炎患者的护理体会. 医学新知, 2020, 30(1): 74-77.
57. 朱豫, 戴晓婧, 华莎, 等. 3 例危重症型冠状病毒肺炎患者应用体外膜肺氧合联合俯卧位通气的护理. 解放军护理杂志, 2020, 37(4): 90-92.
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Chinese Journal of Evidence-Based Medicine

The application of extracorporeal membrane oxygenation in patients with COVID-19: a systematic review and meta-analyses of cohort studies

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