Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis

Atsuyuki Watanabe, Jun Yasuhara, Takaharu Karube, Kae Watanabe, Takuro Shirasu, Hisato Takagi, Naokata Sumitomo, Simon Lee, Toshiki Kuno

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


OBJECTIVES: The indication, complications, and outcomes of extracorporeal membrane oxygenation (ECMO) in children with COVID-19-related illnesses remain unelucidated. Our study aimed to investigate the characteristics and outcomes of ECMO in children with COVID-19-related illnesses. DATA SOURCES: We searched PubMed and EMBASE databases in March 2022. STUDY SELECTION: We retrieved all studies involving children (age ≤ 18 yr) with COVID-19-related illnesses who received ECMO. DATA EXTRACTION: Two authors independently extracted data and assessed the risk of bias. Mortality, successful weaning rate, and complications while on ECMO were synthesized by a one-group meta-analysis using a random-effect model. Meta-regression was performed to explore the risk factors for mortality. DATA SYNTHESIS: We included 18 observational studies, four case series, and 22 case reports involving 110 children with COVID-19-related illnesses receiving ECMO. The median age was 8 years (range, 10 d to 18 yr), and the median body mass index was 21.4 kg/m2(range, 12.3-56.0 kg/m2). The most common comorbidities were obesity (11% [7/63]) and congenital heart disease (11% [7/63]), whereas 48% (30/63) were previously healthy. The most common indications for ECMO were multisystem inflammatory syndrome in children (52% [47/90]) and severe acute respiratory distress syndrome (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 6 days (range, 3-51 d) for venoarterial ECMO and 11 days (range, 3-71 d) for venovenous ECMO. The mortality was 26.6% (95% CI, 15.9-40.9), and the successful weaning rate was 77.0% (95% CI, 55.4-90.1). Complications were seen in 37.0% (95% CI, 23.1-53.5) while on ECMO, including stroke, acute kidney injury, pulmonary edema, and thromboembolism. Corticosteroids and IV immunoglobulin therapies were associated with lower mortality. Conclusions: The mortality of children on ECMO for COVID-19 was relatively low. This invasive treatment can be considered as a treatment option for critically ill children with COVID-19.

Original languageEnglish (US)
Pages (from-to)406-416
Number of pages11
JournalPediatric Critical Care Medicine
Issue number5
StatePublished - May 1 2023


  • COVID-19
  • children
  • extracorporeal life support
  • extracorporeal membrane oxygenation
  • mortality
  • severe acute respiratory syndrome coronavirus-2

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis'. Together they form a unique fingerprint.

Cite this