Extracorporeal membrane oxygenation in COVID-19 associated acute respiratory distress syndrome: A narrative review

Evaluating the Quality and Reliability of YouTube as a Source of Information on Extracorporeal Membrane Oxygenation: A Call to Publish More Quality Videos by Professionals

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) is a medical intervention employed to provide life-sustaining support for patients. YouTube is a dynamic and widely utilized platform for distributing health-related information. The aim of this study was to evaluate ECMO-related videos on YouTube and assess the frequency of misleading information in the accumulation of ECMO videos.

METHODS

On September 17, 2024, an in-depth examination on YouTube was conducted using search phrases "Extracorporeal Membrane Oxygenation" and "ECMO treatment." The study included 55 selected videos. Video parameters and sources were analyzed. Content assessments were conducted utilizing the Global Quality Scale (GQS), the modified DISCERN instrument, the Journal of the American Medical Association (JAMA) Benchmark Criteria, and the Patient Education Materials Assessment Tool for Audio/Visual Materials (PEMAT-A/V). The authors conducted comparisons among quality groups.

RESULTS

Among the 55 videos analyzed, 30.9% (n = 17) were categorized as low quality, 21.8% (n = 12) as intermediate quality, and 47.3% (n = 26) as high quality. Physicians (75%) provided the most high-quality videos. News outlets (83.3%) provided the most low-quality videos. No statistically significant difference was observed between quality groups in daily views, likes, and comments (P > 0.05). Significant correlations were identified between video duration and GQS (r = 0.585), modified DISCERN questionnaire (r = 0.557), JAMA Benchmark Criteria (r = 0.511), PEMAT-A/V Understandability (r = 0.530), and PEMAT-A/V Actionability scores (r = 0.433) (P < 0.001 for all correlation analyses).

CONCLUSION

There is a wide variety in the quality of YouTube ECMO videos. Although YouTube content created by physicians is more likely to provide accurate and beneficial information, substandard videos present a significant public health threat by disseminating misinformation. The critical role of quality control methods on social media platforms in ensuring the accurate and high-quality transmission of health-related information is readily evident.

Survival difference in patients treated with extracorporeal membrane oxygenation in COVID-19 vs. non-COVID ARDS: a systematic review and meta-analysis

INTRODUCTION

The COVID-19 pandemic has emphasized the need for effective management of severe acute respiratory distress syndrome (ARDS) using veno-venous extracorporeal membrane oxygenation (VV-ECMO). This meta-analysis aims to compare the effectiveness and outcomes of ECMO in patients with COVID-19 ARDS versus those with non-COVID ARDS, assessing its role in different respiratory virus infections.

EVIDENCE ACQUISITION

A systematic search was conducted in PubMed, Web of Science, and other relevant databases up to June 30, 2023, to identify studies comparing ECMO use in COVID-19 and non-COVID ARDS cases. This analysis adheres to PRISMA guidelines, with studies rigorously selected based on predefined inclusion and exclusion criteria and assessed for bias using validated tools.

EVIDENCE SYNTHESIS

The meta-analysis included 24 studies with 2,121 patients, revealing that non-COVID ARDS patients treated with ECMO had a lower mortality risk compared to those with COVID-19 ARDS. Specifically, the overall pooled risk difference in survival was -0.11 (95% CI: -0.17 to -0.05, P<0.001), indicating a statistically significant advantage for non-COVID patients. The standardized mean difference for ECMO duration was significantly longer in COVID-19 patients (SMD=0.70, 95% CI: 0.32 to 1.08, P<0.001), reflecting more prolonged treatment needs.

CONCLUSIONS

ECMO serves as a vital intervention in severe ARDS, with differential effectiveness observed between COVID-19 and non-COVID patients. The study's findings underline the need for precise patient selection and tailored ECMO application across different viral etiologies. These insights are crucial for enhancing clinical strategies and resource allocation during ongoing and future pandemics.

Extracorporeal membrane oxygenation support in adult patients: Comparing COVID-19- and non-COVID-19-associated respiratory failure

INTRODUCTION

Extracorporeal membrane oxygenation (ECMO) is a vital intervention for acute respiratory distress syndrome (ARDS), yet its efficacy with coronavirus disease 2019 (COVID-19) remains unknown. This study compared the long-term mortality rates of patients receiving ECMO for COVID-19 with those experiencing other respiratory disease-associated ARDS.

METHODS

This retrospective cohort study included adults with ARDS receiving ECMO for respiratory disease (COVID-19 and non-COVID-19) based on information collected from the National Health Insurance Service of South Korea from February 1, 2020, to December 31, 2021. The primary outcome was all-cause mortality at 6 months and 1 year post-ECMO initiation.

RESULTS

Data from 3094 patients with COVID-19 (N = 1095) and non-COVID-19 respiratory disease-associated ARDS (N = 1999) who received ECMO support were analyzed. Despite a higher Charlson Comorbidity index in the non-COVID group, patients with COVID-19 had higher cumulative mortality rates at 6 months and 1 year post-ECMO initiation compared to those with non-COVID-19 respiratory diseases, after adjusting for confounders. Patients with COVID-19 also experienced longer intensive care unit stays, higher hospitalization costs, longer ECMO and mechanical ventilation durations, and lower intensity coverage.

CONCLUSIONS

Patients with COVID-19 requiring ECMO showed higher mortality rates, possibly due to its distinct long-lasting and potentially fatal consequences compared to other respiratory illnesses.

Outcomes for COVID-19 Patients Undergoing Tracheostomy With or Without Extracorporeal Membrane Oxygenation (ECMO)

Introduction The coronavirus disease 2019 (COVID-19) pandemic led to the more common use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) for adults with acute respiratory distress syndrome (ARDS). While tracheostomy is generally understood to decrease the risks of prolonged endotracheal intubation, there is conflicting data regarding the benefit of tracheostomy in patients on ECMO. The purpose of this study is to determine whether ECMO cannulation before tracheostomy impacted patient outcomes. Methods This is a retrospective chart review of patients who underwent tracheostomy for COVID-19-related ARDS at a tertiary academic center from March 2020 through March 2022. Patients were separated into two groups based on whether they were cannulated for ECMO prior to tracheostomy. Fisher's exact test or Wilcoxon rank sum test was used to compare the two groups. Results A total of 24 patients were included in the study, with 13 in the ECMO group and 11 in the non-ECMO group. There was no significant difference in age, comorbidities, race, or gender between the groups. Patients on ECMO had a longer time from admission to intubation (seven days vs. three days, p=.002), were more likely to have multiple intubations (54% vs 9%, p= .033), had increased rates of postoperative bleeding (62% vs. 18%, p = .047), and had a higher mortality rate (39% vs. 0%, p= .041). Conclusions ECMO cannulation prior to tracheostomy for COVID-19-related ARDS is associated with poorer outcomes. It is unclear whether this is related to a more severe disease burden in these patients. Further study is needed to evaluate this and guide future management.

Extracorporeal Membrane Oxygenation Support and Critically Ill COVID-19 Patient Outcomes: A Population-Based Cohort Study

We selected critically ill patients with coronavirus disease 2019 (COVID-19) who were receiving extracorporeal membrane oxygenation (ECMO) support and had been transferred to experienced centers. Thus, we aimed to evaluate factors that were associated with receiving ECMO support and factors that were associated with patient mortality. Using data from the National Health Insurance Service and Korea Disease Control and Prevention Agency in South Korea, adult patients admitted to an intensive care unit from October 8, 2020, to December 31, 2021, with a main diagnosis of COVID-19 were included. They were divided into two groups: ECMO group (n = 455) and non-ECMO group (n = 12,648). Receiving ECMO support was less associated with old age [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.94-0.96; p  < 0.001], underlying severe disabilities (OR, 0.49; 95% CI, 0.29-0.83; p  = 0.008), and booster vaccination status (second: OR, 0.61; 95% CI, 0.39-0.94; p  = 0.024; third: OR, 0.40; 95% CI, 0.25-0.65; p  < 0.001). In addition, after adjusting for various variables, low mortality in patients with ECMO support was associated with having previously received a second booster vaccination (OR, 0.33; 95% CI, 0.14-0.77; p  = 0.010). Vaccination and booster therapy may lower the need for ECMO support and lower mortality among critically ill patients with COVID-19 with ECMO support.