ABSTRACT
Introduction: The impact of treatment experience with ECMO prior to the COVID-19 pandemic era on the outcomes of ECMO during the COVID-19 pandemic has not been well investigated. The aim of this study was to investigate the differences in the outcomes of ECMO between highvolume hospitals in Japan before the COVID-19 pandemic and low-volume hospitals. Method(s): This is a prospective observational cohort study of patients with fatal COVID-19 pneumonia in Japan receiving ECMO. The association between patient background, high/low-volume hospitals, and survival from February 2020 to November 2021 were evaluated. Prognostic factors were assessed by Kaplan-Meier and Cox proportional hazards analyses. High-volume hospitals were defined as those with a total of at least 20 cases prior to the COVID-19 pandemic era. Result(s): Ten hospitals (1.1% of a total of 900 ICUs in Japan) were classified as high-volume hospitals, with a median number of ECMO cases of 35.5 (IQR, 25.5-40.5). There were a total of 1,214 ECMO cases during the COVID-19 pandemic, of which 1030 (85%) were treated in low-volume hospitals and 184 (15%) were treated in high-volume hospitals. Kaplan-Meier analysis demonstrated slightly better survival in high-volume hospitals in 30-day (p=0.062) and 60-day (p=0.11) survivals, whereas, in 90-day survival, the two groups were almost identical (p=0.87). Cox proportional hazards analysis also failed to demonstrate that high-volume hospital before the COVID-19 pandemic era was independent prognostic factor (HR, 0.97;95%CI, 0.74-1.28). Conclusion(s): In Japan, high-volume hospital prior to the COVID-19 pandemic era was not independent prognostic factor.
ABSTRACT
Background: The virus responsible for COVID-19 enters human cells by binding angiotensinconverting enzyme 2. The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), remains uncertain. Aim: To examine the role of ACEi / ARB exposure on outcomes in COVID-19 patients with preexisting hypertension (HTN) admitted to intensive care units (ICU). Methods: The COVID-19 Critical Care Consortium is a prospective, observational cohort study of patients requiring ICU admission for active COVID-19 spanning 354 participating sites in 54 countries. Patients >18 years old with pre-existing HTN requiring antihypertensive therapy were analysed. Length of stay and in-hospital mortality to 90 days post ICU admission were analysed as time-to-eventoutcomes by multistate survival analysis, and the influence of ACEi / ARB use on the hazards of death and discharge by multi-state Cox proportional hazard modelling and sensitivity analysis. Results: From December 1, 2019 through December 30, 2020, 663 eligible patients were registered. Of these, 480 patients had received ACEi and / or ARB therapy (median age 65 years, 67% male) in the 2 weeks before ICU admission, while 183 had not (66 years, 61% male). Average lengths of ICU and general ward stays were longer in the ACEi / ARB than non-ACEi / ARB group (20.8 days and 6.5 days vs. 15.5 and 6.0 days, respectively). ACEi / ARB use was associated with a decreased hazard of death (HR, 0.69, 95% CI, 0.54 -0.88) that persisted after adjusting for propensity scores (0.67, 0.53 -0.86). Cumulative probabilities (unadjusted for baseline characteristics) for death and discharge post ICU admission are depicted in the figure for ACEi/ARB (red) and non-ACEi / ARB (blue) patients. Conclusions: In 663 critically ill COVID-19 patients with pre-existing HTN, RAAS inhibition pre-ICU admission was linked to reduced in-hospital mortality.