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 respi-ratory 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 data-bases 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 over-all 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 re-source allocation during ongoing and future pandemics.