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Peer-reviewedCC BY-NC-ND 4.0Medical Science Monitor: International Medical Journal of Experimental and Clinical Research

Clinical Outcomes and Complications of Extracorporeal Membrane Oxygenation (ECMO) in Adult Patients With COVID-19 in Central and Eastern Europe: A Systematic Review and Meta-Analysis

  • Konstanty Szułdrzyński1
  • Miłosz Jankowski1
  • Zsolt Molnar2
  • Jan Benes3
  • Adam Piasecki4
  • Michał Matuszewski1
  • Marcin Matuszewski5
  • Zoltán Ruszkai6
  • Jakub Kletecka3
  • Konrad Zuzda1
  • Kamil Adamczyk1
6 affiliations
  1. 1Department of Anaesthesiology and Intensive Care, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  2. 2Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
  3. 3Department of Anesthesiology and Intensive Care, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
  4. 4Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Mölndal, Sweden
  5. 5Military Institute of Medicine – National Research Institute, Warsaw Poland
  6. 6Department of Anesthesiology and Intensive Therapy, Flór Ferenc Hospital, Kistarcsa, Hungary
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for severe COVID-19–related acute respiratory distress syndrome (ARDS). International datasets do not consistently report Central and Eastern Europe (CEE) separately. We aimed to assess mortality, clinical characteristics, and complications of ECMO-treated COVID-19 patients across the CEE region.

Material/Methods: We conducted a systematic review with single-arm meta-analyses of observational studies. PubMed, Scopus, Embase, and Web of Science were searched from January 2020 to August 2025 for studies reporting ECMO outcomes in adult (≥ 18 years) COVID-19 patients from CEE countries, with at least 10 ECMO-treated patients. Conference abstracts and overlapping cohorts were excluded. The study protocol was registered with PROSPERO (CRD420251077593).

Results: Twelve studies included 802 patients from 6 countries. Pooled in-hospital mortality was 65% (95% CI 0.57–0.72; I2 = 70.6%; 10 studies; n = 691), and ICU mortality was 61% (95% CI 0.47–0.74; I2 = 85.8%; 7 studies, n = 526). Country-level in-hospital mortality estimates were 54% for the Czech Republic and 76% for Poland but were descriptive because of the small number of studies and wide CIs. Mean pre-ECMO mechanical ventilation duration was 4.8 days (95% CI 3.7–5.8; I2 = 4.4%), ECMO duration was 17.8 days (95% CI 12.8–22.9; I2 = 79.8%), and ICU length of stay was 23.6 days (95% CI 7.5–39.7; I2 = 92.6%). Serious bleeding occurred in 40% (95% CI 22–61%; I2 = 85.7%). Certainty was very low for all pooled outcomes.

Conclusions: These CEE-specific estimates provide regional benchmarks, but substantial heterogeneity and very low certainty limit international comparisons and country-level interpretation. Standardized regional registries, prospective multicenter data, harmonized complication reporting, and long-term outcome assessment are needed.

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Cite

BibTeXRIS
BibTeX
@article{szuldrzynski2026clinical,
  title = {{Clinical Outcomes and Complications of Extracorporeal Membrane Oxygenation (ECMO) in Adult Patients With COVID-19 in Central and Eastern Europe: A Systematic Review and Meta-Analysis}},
  author = {Konstanty Szułdrzyński and Miłosz Jankowski and Zsolt Molnar and Jan Benes and Adam Piasecki and Michał Matuszewski and Marcin Matuszewski and Zoltán Ruszkai and Jakub Kletecka and Konrad Zuzda and Kamil Adamczyk},
  journal = {Medical Science Monitor: International Medical Journal of Experimental and Clinical Research},
  year = {2026},
  month = oct,
  doi = {10.12659/msm.954002},
  url = {https://doi.org/10.12659/msm.954002},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Clinical Outcomes and Complications of Extracorporeal Membrane Oxygenation (ECMO) in Adult Patients With COVID-19 in Central and Eastern Europe: A Systematic Review and Meta-Analysis
AU  - Konstanty Szułdrzyński
AU  - Miłosz Jankowski
AU  - Zsolt Molnar
AU  - Jan Benes
AU  - Adam Piasecki
AU  - Michał Matuszewski
AU  - Marcin Matuszewski
AU  - Zoltán Ruszkai
AU  - Jakub Kletecka
AU  - Konrad Zuzda
AU  - Kamil Adamczyk
PY  - 2026
DA  - 2026/10/22
JO  - Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
DO  - 10.12659/msm.954002
UR  - https://doi.org/10.12659/msm.954002
AB  - Background: Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for severe COVID-19–related acute respiratory distress syndrome (ARDS). International datasets do not consistently report Central and Eastern Europe (CEE) separately. We aimed to assess mortality, clinical characteristics, and complications of ECMO-treated COVID-19 patients across the CEE region.  Material/Methods: We conducted a systematic review with single-arm meta-analyses of observational studies. PubMed, Scopus, Embase, and Web of Science were searched from January 2020 to August 2025 for studies reporting ECMO outcomes in adult (≥ 18 years) COVID-19 patients from CEE countries, with at least 10 ECMO-treated patients. Conference abstracts and overlapping cohorts were excluded. The study protocol was registered with PROSPERO (CRD420251077593).  Results: Twelve studies included 802 patients from 6 countries. Pooled in-hospital mortality was 65% (95% CI 0.57–0.72; I2 = 70.6%; 10 studies; n = 691), and ICU mortality was 61% (95% CI 0.47–0.74; I2 = 85.8%; 7 studies, n = 526). Country-level in-hospital mortality estimates were 54% for the Czech Republic and 76% for Poland but were descriptive because of the small number of studies and wide CIs. Mean pre-ECMO mechanical ventilation duration was 4.8 days (95% CI 3.7–5.8; I2 = 4.4%), ECMO duration was 17.8 days (95% CI 12.8–22.9; I2 = 79.8%), and ICU length of stay was 23.6 days (95% CI 7.5–39.7; I2 = 92.6%). Serious bleeding occurred in 40% (95% CI 22–61%; I2 = 85.7%). Certainty was very low for all pooled outcomes.  Conclusions: These CEE-specific estimates provide regional benchmarks, but substantial heterogeneity and very low certainty limit international comparisons and country-level interpretation. Standardized regional registries, prospective multicenter data, harmonized complication reporting, and long-term outcome assessment are needed.
SN  - 1234-1010
SN  - 1643-3750
ER  -