Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19

Purpose Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19). Methods We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia ($ PaO_{2} $/$ FiO_{2} $ < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model. Results Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41–58), 137 (72.1%) were men, and the median $ PaO_{2} $/$ FiO_{2} $ prior to ECMO initiation was 72 (IQR 61–90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41–0.74). Results were similar in a secondary analysis limited to patients with $ PaO_{2} $/$ FiO_{2} $ < 80 (HR 0.55; 95% CI 0.40–0.77). Conclusion In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality..

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:47

Enthalten in:

Intensive care medicine - 47(2021), 2 vom: Feb., Seite 208-221

Sprache:

Englisch

Beteiligte Personen:

Shaefi, Shahzad [VerfasserIn]
Brenner, Samantha K. [VerfasserIn]
Gupta, Shruti [VerfasserIn]
O’Gara, Brian P. [VerfasserIn]
Krajewski, Megan L. [VerfasserIn]
Charytan, David M. [VerfasserIn]
Chaudhry, Sobaata [VerfasserIn]
Mirza, Sara H. [VerfasserIn]
Peev, Vasil [VerfasserIn]
Anderson, Mark [VerfasserIn]
Bansal, Anip [VerfasserIn]
Hayek, Salim S. [VerfasserIn]
Srivastava, Anand [VerfasserIn]
Mathews, Kusum S. [VerfasserIn]
Johns, Tanya S. [VerfasserIn]
Leonberg-Yoo, Amanda [VerfasserIn]
Green, Adam [VerfasserIn]
Arunthamakun, Justin [VerfasserIn]
Wille, Keith M. [VerfasserIn]
Shaukat, Tanveer [VerfasserIn]
Singh, Harkarandeep [VerfasserIn]
Admon, Andrew J. [VerfasserIn]
Semler, Matthew W. [VerfasserIn]
Hernán, Miguel A. [VerfasserIn]
Mueller, Ariel L. [VerfasserIn]
Wang, Wei [VerfasserIn]
Leaf, David E. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.69$jIntensivmedizin

Themen:

ARDS
COVID-19
Extracorporeal membrane oxygenation
Mortality
Severe respiratory failure
VV-ECMO

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2021

doi:

10.1007/s00134-020-06331-9

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2123586978

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