Clinical Outcomes and Complications of Extracorporeal Membrane Oxygenation (ECMO) in Adult Patients With COVID-19 in Central and Eastern Europe: A Systematic Review and Meta-Analysis.
Konstanty Szułdrzyński, Miłosz Jankowski, Zsolt Molnar et al.
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In 30 seconds
This systematic review and meta-analysis pooled observational studies of adults with COVID-19 treated with ECMO in Central and Eastern Europe. Twelve studies covered 802 patients from six countries. Pooled in-hospital mortality was 65% (95% CI 0.57-0.72; I²=70.6%; 10 studies; n=691), while serious bleeding occurred in 40% (95% CI 22-61%; I²=85.7%). The authors rated certainty as very low for all pooled outcomes and cautioned that heterogeneity limits international comparisons and interpretation of country-level estimates.
Key findings
- Pooled in-hospital mortality was 65% (95% CI 0.57-0.72; I²=70.6%; 10 studies; n=691).
- Pooled ICU mortality was 61% (95% CI 0.47-0.74; I²=85.8%; 7 studies, n=526).
- Serious bleeding occurred in 40% (95% CI 22-61%; I²=85.7%).
- Country-level in-hospital mortality estimates were 54% for the Czech Republic and 76% for Poland, but were descriptive given few studies and wide CIs.
Why it matters
The review provides regional estimates of mortality and complications among adults with COVID-19 receiving ECMO, addressing a gap in international datasets that do not consistently report Central and Eastern Europe separately. The high pooled mortality and serious bleeding frequency offer context for understanding outcomes, while the very low certainty and substantial heterogeneity mean these estimates should not be treated as precise comparisons across countries or regions.
What to keep in mind
The evidence came from observational studies, with substantial heterogeneity for several outcomes and very low certainty across all pooled outcomes. Country-level estimates were based on few studies and had wide CIs.