tetano
Editor, Senior Moderator
Intensive Care Med
. 2021 Feb 2.
doi: 10.1007/s00134-020-06331-9. Online ahead of print.
Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19
Shahzad Shaefi[SUP] #[/SUP][SUP] 1 [/SUP], Samantha K Brenner[SUP] #[/SUP][SUP] 2 3 [/SUP], Shruti Gupta[SUP] #[/SUP][SUP] 4 [/SUP], Brian P O'Gara[SUP] 5 [/SUP], Megan L Krajewski[SUP] 5 [/SUP], David M Charytan[SUP] 6 [/SUP], Sobaata Chaudhry[SUP] 6 [/SUP], Sara H Mirza[SUP] 7 [/SUP], Vasil Peev[SUP] 8 [/SUP], Mark Anderson[SUP] 9 10 [/SUP], Anip Bansal[SUP] 11 [/SUP], Salim S Hayek[SUP] 12 [/SUP], Anand Srivastava[SUP] 13 [/SUP], Kusum S Mathews[SUP] 14 [/SUP], Tanya S Johns[SUP] 15 [/SUP], Amanda Leonberg-Yoo[SUP] 16 [/SUP], Adam Green[SUP] 17 [/SUP], Justin Arunthamakun[SUP] 18 [/SUP], Keith M Wille[SUP] 19 [/SUP], Tanveer Shaukat[SUP] 4 [/SUP], Harkarandeep Singh[SUP] 4 [/SUP], Andrew J Admon[SUP] 20 [/SUP], Matthew W Semler[SUP] 21 [/SUP], Miguel A Hern?n[SUP] 22 23 [/SUP], Ariel L Mueller[SUP] #[/SUP][SUP] 24 [/SUP], Wei Wang[SUP] #[/SUP][SUP] 25 [/SUP], David E Leaf[SUP] #[/SUP][SUP] 4 [/SUP], STOP-COVID Investigators
Collaborators, Affiliations
Abstract
Purpose: Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19).
Methods: We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model.
Results: Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41-58), 137 (72.1%) were men, and the median PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] prior to ECMO initiation was 72 (IQR 61-90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41-0.74). Results were similar in a secondary analysis limited to patients with PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 80 (HR 0.55; 95% CI 0.40-0.77).
Conclusion: In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.
Keywords: ARDS; COVID-19; Extracorporeal membrane oxygenation; Mortality; Severe respiratory failure; VV-ECMO.
. 2021 Feb 2.
doi: 10.1007/s00134-020-06331-9. Online ahead of print.
Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19
Shahzad Shaefi[SUP] #[/SUP][SUP] 1 [/SUP], Samantha K Brenner[SUP] #[/SUP][SUP] 2 3 [/SUP], Shruti Gupta[SUP] #[/SUP][SUP] 4 [/SUP], Brian P O'Gara[SUP] 5 [/SUP], Megan L Krajewski[SUP] 5 [/SUP], David M Charytan[SUP] 6 [/SUP], Sobaata Chaudhry[SUP] 6 [/SUP], Sara H Mirza[SUP] 7 [/SUP], Vasil Peev[SUP] 8 [/SUP], Mark Anderson[SUP] 9 10 [/SUP], Anip Bansal[SUP] 11 [/SUP], Salim S Hayek[SUP] 12 [/SUP], Anand Srivastava[SUP] 13 [/SUP], Kusum S Mathews[SUP] 14 [/SUP], Tanya S Johns[SUP] 15 [/SUP], Amanda Leonberg-Yoo[SUP] 16 [/SUP], Adam Green[SUP] 17 [/SUP], Justin Arunthamakun[SUP] 18 [/SUP], Keith M Wille[SUP] 19 [/SUP], Tanveer Shaukat[SUP] 4 [/SUP], Harkarandeep Singh[SUP] 4 [/SUP], Andrew J Admon[SUP] 20 [/SUP], Matthew W Semler[SUP] 21 [/SUP], Miguel A Hern?n[SUP] 22 23 [/SUP], Ariel L Mueller[SUP] #[/SUP][SUP] 24 [/SUP], Wei Wang[SUP] #[/SUP][SUP] 25 [/SUP], David E Leaf[SUP] #[/SUP][SUP] 4 [/SUP], STOP-COVID Investigators
Collaborators, Affiliations
- PMID: 33528595
- DOI: 10.1007/s00134-020-06331-9
Abstract
Purpose: Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19).
Methods: We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model.
Results: Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41-58), 137 (72.1%) were men, and the median PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] prior to ECMO initiation was 72 (IQR 61-90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41-0.74). Results were similar in a secondary analysis limited to patients with PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] < 80 (HR 0.55; 95% CI 0.40-0.77).
Conclusion: In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.
Keywords: ARDS; COVID-19; Extracorporeal membrane oxygenation; Mortality; Severe respiratory failure; VV-ECMO.