tetano
Editor, Senior Moderator
Ann Thorac Surg
. 2022 Feb 18;S0003-4975(22)00198-9.
doi: 10.1016/j.athoracsur.2022.01.043. Online ahead of print.
Multi-institutional Analysis of 505 COVID-19 Patients Supported with ECMO: Predictors of Survival
Celeste A Hall[SUP] 1 [/SUP], Jeffrey P Jacobs[SUP] 2 [/SUP], Alfred H Stammers[SUP] 3 [/SUP], James D St Louis[SUP] 4 [/SUP], J W Awori Hayanga[SUP] 5 [/SUP], Michael S Firstenberg[SUP] 6 [/SUP], Linda B Mongero[SUP] 3 [/SUP], Eric A Tesdahl[SUP] 3 [/SUP], Keshava Rajagopal[SUP] 7 [/SUP], Faisal H Cheema[SUP] 8 [/SUP], Kirti Patel[SUP] 3 [/SUP], Tom Coley[SUP] 3 [/SUP], Anthony K Sestokas[SUP] 3 [/SUP], Marvin J Slepian[SUP] 9 [/SUP], Vinay Badhwar[SUP] 5 [/SUP]
Affiliations
Abstract
Background: We reviewed our experience with 505 patients with confirmed COVID-19 supported with ECMO at 45 hospitals and estimated risk factors for mortality.
Methods: A multi-institutional database was created and utilized to assess all patients with COVID-19 who were supported with ECMO. A Bayesian mixed-effects logistic regression model was estimated to assess the effect on survival of days between COVID-19 diagnosis and intubation, as well as age at ECMO cannulation.
Results: Median time on ECMO was 18 days (interquartile range=10-29). All 505 patients have separated from ECMO: 194 patients (38.4%) survived and 311 patients (61.6%) died. Survival with veno-venous ECMO was 184 of 466 patients (39.5%), while survival with veno-arterial ECMO was 8 of 30 patients (26.7%). Survivors had lower median age (44 versus 51 years, p<0.001) and shorter median time interval from diagnosis to intubation (7 days versus 11 days, p=0.001). Adjusting for several confounding factors, we estimated that an ECMO patient intubated on day 14 post COVID-19 diagnosis vs day 4 had a relative odds of survival of 0.65 (95% Credible Interval [CrI]:0.44-0.96, posterior probability of negative effect: 98.5%). Age was also negatively associated with survival: relative to a 38-year-old we estimated that a 57-year-old patient had a relative odds of survival of 0.43 (95% CrI:0.30-0.61, posterior probability of negative effect: >99.99%).
Conclusions: ECMO facilitates salvage and survival of select critically ill patients with COVID-19. Survivors tend to be younger and have shorter time from diagnosis to intubation. Survival of patients supported with only veno-venous ECMO was 39.5%.
Keywords: COVID-19; Coronavirus; Extracorporeal Membrane Oxygenation; Pulmonary failure; acute respiratory distress syndrome.
. 2022 Feb 18;S0003-4975(22)00198-9.
doi: 10.1016/j.athoracsur.2022.01.043. Online ahead of print.
Multi-institutional Analysis of 505 COVID-19 Patients Supported with ECMO: Predictors of Survival
Celeste A Hall[SUP] 1 [/SUP], Jeffrey P Jacobs[SUP] 2 [/SUP], Alfred H Stammers[SUP] 3 [/SUP], James D St Louis[SUP] 4 [/SUP], J W Awori Hayanga[SUP] 5 [/SUP], Michael S Firstenberg[SUP] 6 [/SUP], Linda B Mongero[SUP] 3 [/SUP], Eric A Tesdahl[SUP] 3 [/SUP], Keshava Rajagopal[SUP] 7 [/SUP], Faisal H Cheema[SUP] 8 [/SUP], Kirti Patel[SUP] 3 [/SUP], Tom Coley[SUP] 3 [/SUP], Anthony K Sestokas[SUP] 3 [/SUP], Marvin J Slepian[SUP] 9 [/SUP], Vinay Badhwar[SUP] 5 [/SUP]
Affiliations
- PMID: 35189111
- DOI: 10.1016/j.athoracsur.2022.01.043
Abstract
Background: We reviewed our experience with 505 patients with confirmed COVID-19 supported with ECMO at 45 hospitals and estimated risk factors for mortality.
Methods: A multi-institutional database was created and utilized to assess all patients with COVID-19 who were supported with ECMO. A Bayesian mixed-effects logistic regression model was estimated to assess the effect on survival of days between COVID-19 diagnosis and intubation, as well as age at ECMO cannulation.
Results: Median time on ECMO was 18 days (interquartile range=10-29). All 505 patients have separated from ECMO: 194 patients (38.4%) survived and 311 patients (61.6%) died. Survival with veno-venous ECMO was 184 of 466 patients (39.5%), while survival with veno-arterial ECMO was 8 of 30 patients (26.7%). Survivors had lower median age (44 versus 51 years, p<0.001) and shorter median time interval from diagnosis to intubation (7 days versus 11 days, p=0.001). Adjusting for several confounding factors, we estimated that an ECMO patient intubated on day 14 post COVID-19 diagnosis vs day 4 had a relative odds of survival of 0.65 (95% Credible Interval [CrI]:0.44-0.96, posterior probability of negative effect: 98.5%). Age was also negatively associated with survival: relative to a 38-year-old we estimated that a 57-year-old patient had a relative odds of survival of 0.43 (95% CrI:0.30-0.61, posterior probability of negative effect: >99.99%).
Conclusions: ECMO facilitates salvage and survival of select critically ill patients with COVID-19. Survivors tend to be younger and have shorter time from diagnosis to intubation. Survival of patients supported with only veno-venous ECMO was 39.5%.
Keywords: COVID-19; Coronavirus; Extracorporeal Membrane Oxygenation; Pulmonary failure; acute respiratory distress syndrome.