Effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in critically patients with COVID-19





COVID-19; Extracorporeal Membrane Oxygenation; Eficácia.


Severe cases of COVID-19 may require oxygen support therapies, such as the use of Extracorporeal Oxygenation Membrane (ECMO) and mechanical ventilation (MV). ECMO is a therapy used for temporary support in cases of pulmonary and/or cardiac function failure. This integrative review aimed to assess the scientific literature on the effectiveness of ECMO in critically patients with COVID-19. Articles collected from PubMed, published from December 2019 to June 2021, using the descriptors "COVID-19" and "ECMO" were included in this review. Articles that did not present results on the assessment of the relation between ECMO and COVID-19 and those that fell into the category of letter to the editor model or narrative reviews were excluded. For an integrated discussion, the articles were grouped in a table containing title, objective, method, methodology, results and conclusion. 36 articles were included for the integrative analysis. It was possible to evidence a greater efficacy of ECMO in younger patients (< 71 years), with greater disease severity and in those with comorbidities. However, the therapy has certain types of complications, such as a high risk of thrombosis and circuit failure, which can lead to an unsuccessful weaning from ECMO. ECMO therapy can help critically patients with COVID-19 in certain conditions, although it may increase the risk of thrombosis, and further studies are needed for better clarification.                                                    


Bemtgen, X., Zotzmann, V., Benk, C., Rilinger, J., Steiner, K., Asmussen, A., ... Staudacher, D. L. (2021). Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19. Journal of Thrombosis and Thrombolysis, 51(2)

–307. doi: http://dx.doi.org/10.1007/s11239-020-02217-1

Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., … Lane, H. C. (2020). Remdesivir for the Treatment of COVID-19 — Final Report. England Journal Med, 383(19):1813-1826. doi: http://dx.doi.org/10.1056/NEJMoa2007764

Bleakley, C., Singh, S., Garfield, B., Morosin, M., Surkova, E., Mandalia, M. S., … Price, S. (2021). Right ventricular dysfunction in critically ill COVID-19 ARDS. Journal Cardiologist, 327:251-258. doi: http://dx.doi.org/10.1016/j.ijcard.2020.11.043

Bergman, Z. R., Wothe, J. K., Alwan, F. S., Dunn, A., Lusczek, E. R., Lofrano, A. E., … Brunsvold, M. E. (2021). The Use of Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Infection: One Region’s Comprehensive Experience. Ansaio Journal, 67(5):503-510. doi: http://dx.doi.org/10.1097/MAT.0000000000001403

Chaves, R., Filho, R. R., Timenetsky, K. T., Moreira, F. T., Vilanova, L. C.S., Bravim, B. A., ... Corrêa, T. D. (2019) Extracorporeal membrane oxygenation: a literature review. Hospital Israelita Albert Einsten, 31(3):410-424. Brasil. doi: http://dx.doi.org/10.5935/0103-507X.20190063

Coronavirus Resource Center. University and Medicine John Hopinks, EUA, 2021.Recuperado de: https://coronavirus.jhu.edu/

Davies, P., Evans, C., Kanthimathinathan, H. K., Lillie, J., Brierley, J., Waters, G., … Ramnarayan, P. (2020) Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. Reino Unido, 4(9):669-677. doi: http://dx.doi.org/10.1016/S2352-4642(20)30215-7.

Donatelli, F., Miceli, A., Glauber, M., Cirri, S., Maiello, C., Coscioni, E., ... Napoli, C. (2021). Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience. Interact Cardiovasc Thorac Surg, 31(6):755-762. doi: http://dx.doi.org/10.1093/icvts/ivaa186.

Fang, J., Li, R., Chen, Y., Qin, J., Hu, M., Huang, C, L., … Wei, X. (2021). Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study. Curr Med Sci, 41(1):1-13. doi: http://dx.doi.org/10.1007/s11596-021-2311-8.

Giraud, R., Legouis, D., Assouline, B., Charriere, A., Decosterd, D., Brunner M.-E., … Bendjelid, K. (2021). Timing of VV‐ECMO therapy implementation influences prognosis of COVID‐19 patients. Physiol Rep, 9(3):e14715. doi: http://dx.doi.org/10.14814/phy2.14715

Guo, Z., Sun, L., Li, B., Tian, R., Zhang, X., Zhang Z., … Li, X. (2020). Anticoagulation Management in Severe Coronavirus Disease 2019

Patients on Extracorporeal Membrane Oxygenation. Journal Cardiothorac Vasc Anesthesia, 35(2):389-397. doi: http://dx.doi.org/10.1053/j.jvca.2020.08.067

Hill, J. (1982) Classics in thoracic surgery John H. Gibbon, Jr. Part I. The Development of the First Successful Heart=Lung Machine. The Society of Thoracic Surgeons. Recuperado em: https://www.annalsthoracicsurgery.org/article/S0003-4975(10)62507-6/pdf

Hu, B.-S., Hu, M.-Z., Jiang, L-X., Yu, J., Chang, Y., Cao, Y., … Dai, Z.-P. (2020). Extracorporeal membrane oxygenation (ECMO) in patients with COVID-19: a rapid systematic review of case studies. European Review for Medical and Pharmacological Sciences, 24(22):11945-11952. China. doi: http://dx.doi.org/10.26355/eurrev_202011_23855

Jacobs, J., Stammers, A. H., Loius, J. S., Hayanga, J. W. A., Firstenberg, M. S., Mongero, L. B., … Badhwar, V. J. (2021). Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time. Ansaio Journal, 67(5): 496–502. doi: http://dx.doi.org/ 10.1097/MAT.0000000000001434

Jenner, W. J., Kanji R., Mirsadraee, S., Gue, Y. X., Price, S., Prasad, S., … Gorog, D. A. (2021). Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review. Journal Thromb Thrombolysis. 51(3):595-607. doi: http://dx.doi.org/10.1007/s11239-021-02394-7

Kache, S., Chisti, M. J., Gumbo, F., Mupere, E., Zhi, X., Nallasamy, K., … Carcillo, J. (2020). COVID-19 PICU guidelines: for high- and limited-resource settings. Pediatric Research, 88(5):705-716. doi: http://dx.doi.org/ 10.1038/s41390-020-1053-9

Kaushik, S., Aydin, S., Derespina, K. R., Bansal, P. B., Kowals, S., Trachtman, R., … Medar, S. S. (2020). Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): A multi-institutional study from New York City. Journal Pediatric, 224: 24–29. Nova York. doi: http://dx.doi.org/10.1016/j.jpeds.2020.06.045

Köche, J. C. (2011). Fundamentos de metodologia científica. Editora Vozes. Retrieved from: https://www.academia.edu/download/38106165/192008010-Fundamentos-de-Metodologia-Cien-Jose-Carlos-Koche-pdf_1.pdf.

Kowalewski, M., Fina, D., Stomka, A., Raffa, G. M., Martucci, G., Coco, V. L., … Lorusso, R. (2020). COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review. Critical Care. Holanda. 10p. Recuperado em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209766/pdf/13054_2020_Article_2925.pdf

Lei, C., Lin, W., Hu F., Chen, F., Cai, W., Li, Y., ... Li, L. (2020). Factors associated with clinical outcomes in patients with Coronavirus Disease 2019 in Guangzhou, China. Journal Clin Virol, 133:104661. doi: http://dx.doi.org/10.1016/j.jcv.2020.104661

Liu, J., Dong, Y.-Q., Yin, J., He, G., Wu, X., Li, J., … He, X. (2020). Critically ill patients with COVID-19 with ECMO and artificial liver plasma Exchange. Medicine Baltimore, 99(26):e21012. doi: http://dx.doi.org/10.1097/MD.0000000000021012

Martinelli, A, W., Ingle, T., Newman, J., Nadeem, I., Jackson, K., Lane, N. D., … Marciniak, S. J. (2020). COVID-19 and pneumothorax: a multicentre retrospective case series. European Respiratory Journal, 56(5):2002697. Reino Unido. doi: http://dx.doi.org/10.1183/13993003.02697-2020

Meyts, I., Bucciol, G., Quinti, I., Neven, B., Fischer, A., Seoane, E., … Tangye, S. (2020). Coronavirus disease 2019 in patients with inborn errors of immunity: An international study. Journal Allergy Clin Immunology, 147(2):520-531. doi: http://dx.doi.org/10.1016/j.jaci.2020.09.010

Murthy, S., Archambault, P. M., Atique, A., Carrier, F. M., Cheng, M. P., Codan, C., … Wood, G. (2021). Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study. CMAJ Open, 9(1):E181-E188. doi: http://dx.doi.org/10.9778/cmajo.20200250

Mulcahy, C., Smith, M. G., Mamidi, I. S., Thakkar, P. G., Edwards, H., Tummala, N., … Tracy, L. F. (2020). Oropharyngeal hemorrhage in patients with COVID-19: A multiinstitutional case series. Am Journal Otolaryngol, 41(6):102691. doi: http://dx.doi.org/10.1016/j.amjoto.2020.102691

Parzy, G., Daviet, F., Puech, B., Sylvestre, A., Guervilly, C., Porto, A., … Forel, J.-M. (2020) Venous Thromboembolism Events Following Venovenous Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Syndrome Coronavirus 2 Based on CT Scans. Critical Care Med, 48(10):e971-e975. França. doi: http://dx.doi.org/10.1097/CCM.0000000000004504

Radia, T., Williams, N., Agrawal, P., Harman, K., Weale, J., Cook, J., … Gupta, A. (2020). Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Elsevier Public Health Collection, 38:51-57. doi: http://dx.doi.org/10.1016/j.prrv.2020.08.001

Ribeiro, T. (2020) Suporte Respiratório da COVID-19: qual o papel da ECMO. Jornal Brasileiro de Cirurgia Cardiovascular. Brasil. Recuperado em: https://blog.bjcvs.org/single-post/2020/04/03/suporte-respiratorio-na-COVID-19-qual-o-papel-da-ecmo/

Rieder, M., Wengenmayer, T., Staudacher, D., Duerschmied, D., & Supady, A. (2020). Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation. Critical Care, 24(1):435. Alemanha. doi: http://dx.doi.org/10.1186/s13054-020-03130-y

Rezagholizadeh, A., Khiali, S., Sarbakhsh, P., & Maleki, T. E. (2021). Remdesivir for treatment of COVID-19; an updated systematic review and meta-analysis. European Journal Pharmacol, 897:173926. doi: http://dx.doi.org/10.1016/j.ejphar.2021.173926

Roedl, K., Jarczak, D., Thasler, L., Bachmann, M., Schulte, F., Bein, B., … Kluge, S. (2020). Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany. Aust Critical Care, 34(2):167-175. doi: http://dx.doi.org/10.1016/j.aucc.2020.10.009.

Sanders, J. M., Monogue, M. L., Jodlowski, T. Z., & Cutrell, J. B., (2020). Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome. Emerg Infect Dis, 323(18):1824-1836. doi: http://dx.doi.org/10.1001/jama.2020.6019

Shaefi, S., Ma, X., Liang, M., Ding, M., Liu, W., Ma, H., Zhou, X., ... Ren, H. (2021). Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19. Intensive Care Med, 26:e925364. doi: http://dx.doi.org/10.12659/MSM.925364

Silva, ML, Alves, IOB, Ribeiro, CHMA & Lo Prete, AC. Relação da coagulação intravascular disseminada pela determinação do dímero-D com a COVID-19: uma revisão integrativa. Research, Society and Development, 11(1), e21011225731, 2022. doi: http://dx.doi.org/10.33448/rsd-v11i2.25731

Supady, A., Taccone, F. S., Lepper, P. M., Ziegeler, S., & Staudacher, D. L. (2021). Survival after extracorporeal membrane oxygenation in severe COVID-19 ARDS: results from an international multicenter registry. Critical Care, 25(1):90. doi: http://dx.doi.org/10.1186/s13054-021-03486-9

Sultan, I., Habertheuer, A., Usman, A. A., Kilic, A., Gnall, A., Friscia, M. E., … Gutsche, J. (2020). The role of extracorporeal life support for patients with COVID‐19: Preliminary results from a statewide experience. Wiley Public Health Emergency Collection, 35(7):1410-1413. doi: http://dx.doi.org/10.1111/jocs.14583

Savasi, V., Parisi, F., Patane, L., Ferrazzi, E., Frigerio, L., Pellegrino, A., ... Cetin, I. (2020). Clinical Findings and Disease Severity in Hospitalized Pregnant Women with Coronavirus Disease 2019 (COVID-19). Journal Logo, 136(2):252-258. doi: http://dx.doi.org/10.1097/AOG.0000000000003979

Suwalski, P., Rydzewski, A., Wojtowicz, R., Drobinski, D., Walecki, J., ... Wierzba, W. (2021). Severe respiratory failure in the course of coronavirus disease 2019 treated with extracorporeal membrane oxygenation. Kardiol Pol., 78(9):913-915. doi: http://dx.doi.org/10.33963/KP.15444

Tan, E., Song, J., Deane, A. M., & Plummer, M. P. (2021). Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU. Chest. 159(2):524-536. doi: http://dx.doi.org/10.1016/j.chest.2020.10.014

Umakanthan, S., Sahu, P., Ranade, A., Bukelo, M., Rao, J., Machado, L., … KV, D. (2020). Origin, transmission, diagnosis and managemente of coronavírus disease 2019 (COVID-19). Postgrad Med J. Trindade e Tobago. Recuperado em: https://pmj.bmj.com/content/postgradmedj/96/1142/753.full.pdf.

Vogel, J. P., Tendal, B., Giles, M., Whitehead, C., Burton, W., Chakraborty, S., … Homer, C. E. (2020). Clinical care of pregnant and postpartum women with COVID‐19: Living recommendations from the National COVID‐19 Clinical Evidence. Journal Obstet Gynaecol, 60(6):840-851. doi: http://dx.doi.org/10.1111/ajo.13270

Wang, M.-Y., Zhao, R., Gao, L.-J., Gao, X.-F., Wang, D.-P., … Cao, J.-M. (2020). SARS-CoV-2: Structure, Biology, and structure-basaed therapeutics development. Frontiers in Cellular and Infection Microbiology. China. doi: http://dx.doi.org/10.3389/fcimb.2020.587269

Weiss, T. T., Cerda, F., Scott, J. B., Kaur, R., Sungurlu, S., Mirza, S. H., … Li, J. (2021). Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. Br Journal Anaesth,126(1):48-55. doi: http://dx.doi.org/10.1016/j.bja.2020.09.042

Weber, A. G., Chau, A. S., Egeblad, M., Barnes, B. J., & Janowitz, T. (2020). Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series. Mol Med. doi: http://dx.doi.org/10.1101/2020.05.13.20087734

Williams, G. W., Berg, N. K., Reskallah, A., Yuan, X., & Eltzschinh, H. K. (2021). Acute Respiratory Distress Syndrome Contemporary Management and Novel Approaches during COVID-19. Anesthesiology, 134, 270–282. doi: http://dx.doi.org/10.1097/ALN.0000000000003571

Zhou, X., Cheng, Z., Shu, D., Lin, W., Ming, Z., Chen, W., … Hu, Y. (2020). Characteristics of mortal COVID-19 cases compared to the survivors. Aging, 12(24):24579-24595. doi: http://dx.doi.org/10.18632/aging.202216



How to Cite

LAVEZZO, S. Z. .; BELTRAME, S. E. .; RIBEIRO, C. H. M. A. .; PRETE, A. C. L. . Effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in critically patients with COVID-19 . Research, Society and Development, [S. l.], v. 11, n. 3, p. e5911326388, 2022. DOI: 10.33448/rsd-v11i3.26388. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/26388. Acesso em: 9 dec. 2023.



Health Sciences