. 2024 Jun 27;14(1):14835.
doi: 10.1038/s41598-024-64949-x. ECMO is associated with decreased hospital mortality in COVID-19 ARDS
Won-Young Kim # 1 , Sun-Young Jung # 2 , Jeong-Yeon Kim # 2 , Ganghee Chae 3 , Junghyun Kim 4 , Joon-Sung Joh 5 , Tae Yun Park 6 , Ae-Rin Baek 7 , Yangjin Jegal 3 , Chi Ryang Chung 8 , Jinwoo Lee 9 , Young-Jae Cho 10 , Joo Hun Park 11 , Jung Hwa Hwang 12 , Jin Woo Song 13
Affiliations
- PMID: 38937516
- DOI: 10.1038/s41598-024-64949-x
This study determined whether compared to conventional mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) is associated with decreased hospital mortality or fibrotic changes in patients with COVID-19 acute respiratory distress syndrome. A cohort of 72 patients treated with ECMO and 390 with conventional MV were analyzed (February 2020-December 2021). A target trial was emulated comparing the treatment strategies of initiating ECMO vs no ECMO within 7 days of MV in patients with a PaO2/FiO2 < 80 or a PaCO2 ≥ 60 mmHg. A total of 222 patients met the eligibility criteria for the emulated trial, among whom 42 initiated ECMO. ECMO was associated with a lower risk of hospital mortality (hazard ratio [HR], 0.56; 95% confidence interval [CI] 0.36-0.96). The risk was lower in patients who were younger (age < 70 years), had less comorbidities (Charlson comorbidity index < 2), underwent prone positioning before ECMO, and had driving pressures ≥ 15 cmH2O at inclusion. Furthermore, ECMO was associated with a lower risk of fibrotic changes (HR, 0.30; 95% CI 0.11-0.70). However, the finding was limited due to relatively small number of patients and differences in observability between the ECMO and conventional MV groups.