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Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry.
Barbaro, Ryan P; MacLaren, Graeme; Boonstra, Philip S; Combes, Alain; Agerstrand, Cara; Annich, Gail; Diaz, Rodrigo; Fan, Eddy; Hryniewicz, Katarzyna; Lorusso, Roberto; Paden, Matthew L; Stead, Christine M; Swol, Justyna; Iwashyna, Theodore J; Slutsky, Arthur S; Brodie, Daniel.
  • Barbaro RP; Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address: barbaror@med.umich.edu.
  • MacLaren G; Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health System, Singapore.
  • Boonstra PS; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
  • Combes A; Sorbonne Université, INSERM, UMRS1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Sorbonne Hôpital Pitié-Salpêtrière, Paris, France.
  • Agerstrand C; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
  • Annich G; Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
  • Diaz R; Clinica Las Condes, Santiago, Chile.
  • Fan E; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
  • Hryniewicz K; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
  • Lorusso R; Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
  • Paden ML; Division of Pediatric Critical Care, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
  • Stead CM; Extracorporeal Life Support Organization, Ann Arbor, MI, USA.
  • Swol J; Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany.
  • Iwashyna TJ; Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
  • Slutsky AS; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
  • Brodie D; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / Hospital Mortality / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Lancet Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / Hospital Mortality / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Lancet Year: 2021 Document Type: Article