EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) VS CONVENTIONAL MECHANICAL VENTILATION FOR SEVERE ACUTE RESPIRATORY FAILURE DUE TO COVID-19: A MULTICENTER MATCHED COHORT STUDY
Chest
; 162(4):A978-A979, 2022.
Article
in English
| EMBASE | ID: covidwho-2060744
ABSTRACT
SESSION TITLE Critical Care Management of COVID-19 SESSION TYPE Original Investigations PRESENTED ON 10/17/2022 0130 pm - 0230 pm PURPOSE:
Extracorporeal membrane oxygenation (ECMO), typically veno-venous, is used to treat COVID19 patients with severe acute respiratory distress syndrome (ARDS) and is associated with decreased mortality in some reports. This study sought to determine the effect of ECMO versus conventional invasive mechanical ventilation (IMV) on hospital mortality for ARDS due to COVID19, and to compare functional status at discharge.METHODS:
This was a retrospective, multicenter cohort study of adult patients admitted for COVID19 within a large US hospital network between March 1, 2020 and October 31, 2021. Patients were included if they required IMV with a fraction of inspired oxygen (FiO2) of at least 80% or VV ECMO. Patients were excluded if they were not independent, had a history of severe neurologic impairment, chronic obstructive pulmonary disease, chronic systolic heart failure, end stage renal disease, cirrhosis, metastatic malignancy, or a length of stay <24 hours. ECMO criteria and management were at the discretion of the treating center. Conventional IMV patients were assigned a randomized pseudo-baseline, and coarsened exact matching was used to match ECMO to conventional IMV patients based on age, sex, body mass index, pre-baseline severity of hypoxemia, prone positioning, receipt of corticosteroids, Tocilizumab, Baricitinib, acute renal replacement therapy, and vasopressors. Differences in hospital mortality and discharge destination were assessed through weighted logistic regression and weighted multinomial logit regression, respectively.RESULTS:
We identified 207,965 patients across 168 hospitals for review, and 10,571 patients met study criteria. After matching, 275 ECMO patients and 5,808 conventional IMV patients were available for comparison. ECMO was associated with a significant mortality reduction, 36% versus 61% (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.34-0.57). Compared to conventional IMV survivors, ECMO survivors were significantly more likely to be discharged to acute rehabilitation than long term acute care (relative risk ratio (RRR) 2.23, 95% CI 1.16-4.32). ECMO survivors were also significantly more likely to be discharged to another acute care hospital for further management (RRR 3.21, 95% CI 1.75-5.92).CONCLUSIONS:
This study demonstrates that ECMO support is significantly associated with reduced mortality in patients with severe ARDS due to COVID19 compared to conventional invasive mechanical ventilation. Further studies are needed to aid in prognostication, patient selection, and timing of intervention to maximize the benefit of this limited resource. CLINICAL IMPLICATIONS These findings illustrate the importance of timely referral to an ECMO center for severely ill COVID19 patients, and may influence ECMO-capable centers to expand the use of ECMO in appropriate patients for this indication. DISCLOSURES No relevant relationships by Elliott Cohen No relevant relationships by Katherine Cyr No relevant relationships by Jeffrey DellaVolpe No relevant relationships by Jamie Jarzembowski No relevant relationships by Chandra Kunavarapu no disclosure on file for Thomas Mcrae;Employee relationship with HCA Healthcare Please note 6/1/2017 to current Added 04/04/2022 by Daniel Schlauch, value=Salary No relevant relationships by Owen Stell No relevant relationships by sage whitmore
baricitinib; corticosteroid; tocilizumab; acute respiratory failure; adult; adult respiratory distress syndrome; artificial ventilation; body mass; cancer patient; cancer survival; chronic obstructive lung disease; cohort analysis; conference abstract; controlled study; coronavirus disease 2019; drug therapy; emergency care; employee; end stage renal disease; extracorporeal oxygenation; female; fraction of inspired oxygen; functional status; hospital mortality; human; hypoxemia; in-hospital mortality; intensive care; intermittent mandatory ventilation; invasive ventilation; length of stay; liver cirrhosis; major clinical study; male; malignant neoplasm; mortality; multicenter study; multinomial logistic regression; neurologic disease; patient referral; patient selection; randomized controlled trial; rehabilitation; renal replacement therapy; retrospective study; risk factor; salary; survivor; systolic heart failure; veno-venous ECMO
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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