Adjuvant treatments to invasive mechanical ventilation in the management of acute respiratory distress syndrome secondary to COVID-19.
I Escribano-Santana, M L Martínez-Gimeno, L Herráiz-Bermejo
PMID 36934078WHAT IT FOUND
Pooled ICU reports found 44% deaths among 221 ventilated patients with ARDS and COVID-19, and 39% among 117 patients treated with ECMO support.
These are observational summaries, not proof ECMO or other supports reduced mortality.
Key findings
01The pooled analysis of 221 ventilated patients reported 98 deaths, a mortality rate of 44%.
02In a separate pooled analysis of 117 patients, 76 (65%) received combined invasive ventilation, prone positioning and ECMO, and 46 (39%) died.
03Reported ECMO complications in 76 patients included renal failure requiring continuous renal replacement therapy in 21 (28%), bleeding at the cannulation site in 18 (24%), and major haemorrhage in 13 (17%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were descriptive or case series, not trials, so they describe what happened rather than prove a treatment worked. The authors say small sample sizes and case-series focus make results impossible to extrapolate. Some studies did not complete follow-up, which the authors say gives biased results. Patients often received invasive ventilation, prone positioning, neuromuscular blockade, inhaled nitric oxide and ECMO together, so the contribution of any single treatment cannot be separated. The review found few studies and no clinical trials, partly because of pandemic urgency and ethical limits. Nursing care and training findings came from only 2 studies.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the 39% mortality as proof that ECMO reduces death. The review pooled mostly descriptive studies and case series, patients received several treatments at once, and the authors say small samples and study designs make the results impossible to extrapolate.