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Delayed Initiation of ECMO Is Associated With Poor Outcomes in Patients With Severe COVID-19: A Multicenter Retrospective Cohort Study.
Li, Xuyan; Hu, Ming; Zheng, Ruiqiang; Wang, Yishan; Kang, Hanyujie; Jiang, Li; Zhong, Ming; Sang, Ling; Zheng, Xia; Pan, Chun; Zhang, Wei; Qiu, Haibo; Du, Bin; Tong, Zhaohui.
  • Li X; Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
  • Hu M; Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China.
  • Zheng R; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, China.
  • Wang Y; Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
  • Kang H; Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
  • Jiang L; Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Zhong M; Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
  • Sang L; Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
  • Zheng X; Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
  • Pan C; Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
  • Zhang W; Emergency Department, The 900th Hospital of Joint Service Corps of Chinese People's Liberation Army (PLA), Fuzhou, China.
  • Qiu H; Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
  • Du B; Medical Intensive Care Unit (ICU), Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
  • Tong Z; Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne) ; 8: 716086, 2021.
Article in English | MEDLINE | ID: covidwho-1450817
ABSTRACT

Background:

Extracorporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. However, the information on the application of ECMO in severe coronavirus disease 2019 (COVID-19) is limited, such as the initiation time. Especially in the period and regions of ECMO instrument shortage, not all the listed patients could be treated with ECMO in time. This study aimed to investigate and clarify the timing of ECMO initiation related to the outcomes of severe patients with COVID-19. The results show that ECMO should be initiated within 24 h after the criteria are met.

Methods:

In this retrospective, multicenter cohort study, we enrolled all ECMO patients with confirmed COVID-19 at the three hospitals between December 29, 2019 and April 5, 2020. Data on the demographics, clinical presentation, laboratory profile, clinical course, treatments, complications, and outcomes were collected. The primary outcomes were successful ECMO weaning rate and 60-day mortality after ECMO. Successful weaning from ECMO means that the condition of patients improved with adequate oxygenation and gas exchange, as shown by the vital signs, blood gases, and chest X-ray, and the patient was weaned from ECMO for at least 48 h.

Results:

A total of 31 patients were included in the analysis. The 60-day mortality rate after ECMO was 71%, and the ECMO weaning rate was 26%. Patients were divided into a delayed ECMO group [3 (interquartile range (IQR), 2-5) days] and an early ECMO group [0.5 (IQR, 0-1) days] based on the time between meeting the ECMO criteria and ECMO initiation. In this study, 14 and 17 patients were included in the early and delayed treatment groups, respectively. Early initiation of ECMO was associated with decreased 60-day mortality after ECMO (50 vs. 88%, P = 0.044) and an increased ECMO weaning rate (50 vs. 6%, P = 0.011).

Conclusions:

In ECMO-supported patients with COVID-19, delayed initiation of ECMO is a risk factor associated with a poorer outcome. Trial Registration Clinical trial submission March 19, 2020. Registry name A medical records-based study for the clinical application of extracorporeal membrane oxygenation in the treatment of severe respiratory failure patients with novel coronavirus pneumonia (COVID-19). Chinese Clinical Trial Registry https//www.chictr.org.cn/showproj.aspx?proj=51267,identifier~ChiCTR2000030947.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Language: English Journal: Front Med (Lausanne) Year: 2021 Document Type: Article Affiliation country: Fmed.2021.716086

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Language: English Journal: Front Med (Lausanne) Year: 2021 Document Type: Article Affiliation country: Fmed.2021.716086