Faculty of Medicine, University of Tripoli Tripoli, Tripoli, Libya
Background: COVID-19 is a highly infectious disease caused by the novel coronavirus that has affected people of all ages, leading to over 6.6 million deaths worldwide as of December 2022. Children with COVID-19 may present with milder symptoms than adults, but some children may develop severe illnesses such as acute respiratory distress syndrome (ARDS), multisystem inflammatory syndrome in children (MIS-C), and fulminant myocarditis, which may require extracorporeal membrane oxygenation (ECMO) therapy. ECMO is a life-supportive treatment that involves the use of a machine to oxygenate the blood outside the body and pump it back into the circulation. ECMO has been widely used to treat severe ARDS in adults, but there is limited evidence on its use in children with COVID-19. Objective: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of ECMO in children with COVID-19 in terms of mortality rate, rate of successful weaning, and frequency of complications. Design/Methods: A comprehensive search of electronic databases, including PubMed, Cochrane Library, and EMBASE was conducted to identify relevant studies published up to December 2022. The inclusion criteria for the studies were observational studies and case series with 5 or more patients that reported on the use of ECMO in children with COVID-19. Statistical analysis was conducted using R version 4.0.3 and the metafor and meta packages. Results: A total of 7 studies involving 73 children with COVID-19 who received ECMO were identified in the search. The pooled estimate of mortality in children receiving ECMO was 21.5% (15 out of 73 patients; 95% CI: 9.9% to 40.5%; I2 = 14%). The success rate for weaning off/ decannulation ECMO was estimated to be 85.1% (52 out of 61 patients; 95% CI, 67.8–93.9; I2 = 1%). The overall complication rate was 32.6% (14 out of 43; 95% CI, 20.3–47.7; I2 = 0%).
Conclusion(s): The results of this systematic review and meta-analysis suggest that ECMO may be a useful treatment option for children with severe COVID-19, particularly those requiring mechanical ventilation. However, the small sample size and high risk of bias in the included studies limit the overall quality of the evidence. Further comparative research is needed to confirm these findings and determine the optimal use of ECMO in children with COVID-19.
