Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19 : An Emulated Target Trial Analysis
Rationale: Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. Objectives: To estimate the effect of ECMO on 90-day mortality versus IMV only. Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO versus no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 < 80 or PaCO2 ⩾ 60 mm Hg). We controlled for confounding using a multivariable Cox model on the basis of predefined variables. Measurements and Main Results: A total of 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability on Day 7 from the onset of eligibility criteria (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0-9%), which decreased during follow-up (survival on Day 90: 63% vs. 65%; risk difference, -2%; 95% confidence interval, -10 to 5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand and when initiated within the first 4 days of IMV and in patients who are profoundly hypoxemic. Conclusions: In an emulated trial on the basis of a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and regions with ECMO capacities specifically organized to handle high demand.
| Errataetall: |
CommentIn: Am J Respir Crit Care Med. 2022 Aug 1;206(3):236-239. - PMID 35608543 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:206 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - 206(2022), 3 vom: 01. Aug., Seite 281-294 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hajage, David [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory distress syndrome |
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| Anmerkungen: |
Date Completed 03.08.2022 Date Revised 10.02.2024 published: Print CommentIn: Am J Respir Crit Care Med. 2022 Aug 1;206(3):236-239. - PMID 35608543 Citation Status MEDLINE |
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| doi: |
10.1164/rccm.202111-2495OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM340614366 |
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| 100 | 1 | |a Hajage, David |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19 |b An Emulated Target Trial Analysis |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Revised 10.02.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Am J Respir Crit Care Med. 2022 Aug 1;206(3):236-239. - PMID 35608543 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. Objectives: To estimate the effect of ECMO on 90-day mortality versus IMV only. Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO versus no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 < 80 or PaCO2 ⩾ 60 mm Hg). We controlled for confounding using a multivariable Cox model on the basis of predefined variables. Measurements and Main Results: A total of 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability on Day 7 from the onset of eligibility criteria (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0-9%), which decreased during follow-up (survival on Day 90: 63% vs. 65%; risk difference, -2%; 95% confidence interval, -10 to 5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand and when initiated within the first 4 days of IMV and in patients who are profoundly hypoxemic. Conclusions: In an emulated trial on the basis of a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and regions with ECMO capacities specifically organized to handle high demand | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a acute respiratory distress syndrome | |
| 650 | 4 | |a emulated target trial | |
| 650 | 4 | |a extracorporeal membrane oxygenation | |
| 700 | 1 | |a Combes, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Guervilly, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Lebreton, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Mercat, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Pavot, Arthur |e verfasserin |4 aut | |
| 700 | 1 | |a Nseir, Saad |e verfasserin |4 aut | |
| 700 | 1 | |a Mekontso-Dessap, Armand |e verfasserin |4 aut | |
| 700 | 1 | |a Mongardon, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Mira, Jean Paul |e verfasserin |4 aut | |
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| 700 | 1 | |a Beurton, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a Tachon, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Kontar, Loay |e verfasserin |4 aut | |
| 700 | 1 | |a Le Terrier, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Richard, Jean Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Mégarbane, Bruno |e verfasserin |4 aut | |
| 700 | 1 | |a Keogh, Ruth H |e verfasserin |4 aut | |
| 700 | 1 | |a Belot, Aurélien |e verfasserin |4 aut | |
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| 700 | 1 | |a Leyrat, Clémence |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, Matthieu |e verfasserin |4 aut | |
| 700 | 0 | |a COVID-ICU Investigators |e verfasserin |4 aut | |
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