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1.
Crit Care ; 25(1): 355, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-1463260

ABSTRACT

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020. METHODS: We included consecutive adults diagnosed with COVID-19 in Paris-Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression. RESULTS: Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27-47%) and 48% (37-60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02-5.07). ECMO-related complications did not differ between study periods. CONCLUSIONS: 90-day mortality of ECMO-supported COVID-19-ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.


Subject(s)
COVID-19/mortality , Extracorporeal Membrane Oxygenation/mortality , Extracorporeal Membrane Oxygenation/trends , Hospitalization/trends , Respiratory Distress Syndrome/mortality , Severity of Illness Index , Adult , COVID-19/therapy , Cohort Studies , Female , Follow-Up Studies , Humans , Intensive Care Units/trends , Male , Middle Aged , Mortality/trends , Paris/epidemiology , Respiratory Distress Syndrome/therapy , Treatment Outcome
2.
Lancet ; 398(10307): 1230-1238, 2021 10 02.
Article in English | MEDLINE | ID: covidwho-1440421

ABSTRACT

BACKGROUND: Over the course of the COVID-19 pandemic, the care of patients with COVID-19 has changed and the use of extracorporeal membrane oxygenation (ECMO) has increased. We aimed to examine patient selection, treatments, outcomes, and ECMO centre characteristics over the course of the pandemic to date. METHODS: We retrospectively analysed the Extracorporeal Life Support Organization Registry and COVID-19 Addendum to compare three groups of ECMO-supported patients with COVID-19 (aged ≥16 years). At early-adopting centres-ie, those using ECMO support for COVID-19 throughout 2020-we compared patients who started ECMO on or before May 1, 2020 (group A1), and between May 2 and Dec 31, 2020 (group A2). Late-adopting centres were those that provided ECMO for COVID-19 only after May 1, 2020 (group B). The primary outcome was in-hospital mortality in a time-to-event analysis assessed 90 days after ECMO initiation. A Cox proportional hazards model was fit to compare the patient and centre-level adjusted relative risk of mortality among the groups. FINDINGS: In 2020, 4812 patients with COVID-19 received ECMO across 349 centres within 41 countries. For early-adopting centres, the cumulative incidence of in-hospital mortality 90 days after ECMO initiation was 36·9% (95% CI 34·1-39·7) in patients who started ECMO on or before May 1 (group A1) versus 51·9% (50·0-53·8) after May 1 (group A2); at late-adopting centres (group B), it was 58·9% (55·4-62·3). Relative to patients in group A2, group A1 patients had a lower adjusted relative risk of in-hospital mortality 90 days after ECMO (hazard ratio 0·82 [0·70-0·96]), whereas group B patients had a higher adjusted relative risk (1·42 [1·17-1·73]). INTERPRETATION: Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers. FUNDING: None.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation/methods , Hospital Mortality/trends , Respiratory Distress Syndrome/therapy , Adult , COVID-19/mortality , Duration of Therapy , Extracorporeal Membrane Oxygenation/trends , Female , Humans , Male , Middle Aged , Patient Selection , Practice Guidelines as Topic , Registries , Respiratory Distress Syndrome/mortality , SARS-CoV-2
3.
Crit Care ; 25(1): 315, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1383659

ABSTRACT

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at  https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from  https://link.springer.com/bookseries/8901 .


Subject(s)
Extracorporeal Membrane Oxygenation/adverse effects , Patient Positioning/standards , Prone Position/physiology , Respiratory Distress Syndrome/physiopathology , Extracorporeal Membrane Oxygenation/methods , Extracorporeal Membrane Oxygenation/trends , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Patient Positioning/methods , Respiratory Distress Syndrome/complications , Survival Analysis
4.
Respir Res ; 22(1): 195, 2021 Jul 05.
Article in English | MEDLINE | ID: covidwho-1296608

ABSTRACT

BACKGROUND: Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. METHODS: We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. RESULTS: A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. CONCLUSIONS: At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.


Subject(s)
Extracorporeal Membrane Oxygenation/mortality , Extracorporeal Membrane Oxygenation/methods , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/mortality , Respiratory Insufficiency/therapy , Adult , Aged , Chronic Disease , Cohort Studies , Extracorporeal Membrane Oxygenation/trends , Humans , Middle Aged , Republic of Korea/epidemiology , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/mortality , Respiratory Insufficiency/diagnosis , Retrospective Studies , Survival Rate/trends
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