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02.02.2021 | COVID-19 | Original Zur Zeit gratis

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

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

Erschienen in: Intensive Care Medicine | Ausgabe 2/2021

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Abstract

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 (PaO₂/FiO₂ < 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 PaO₂/FiO₂ 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 PaO₂/FiO₂ < 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.

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Titel: Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19
verfasst von: Shahzad Shaefi
Samantha K. Brenner
Shruti Gupta
Brian P. O’Gara
Megan L. Krajewski
David M. Charytan
Sobaata Chaudhry
Sara H. Mirza
Vasil Peev
Mark Anderson
Anip Bansal
Salim S. Hayek
Anand Srivastava
Kusum S. Mathews
Tanya S. Johns
Amanda Leonberg-Yoo
Adam Green
Justin Arunthamakun
Keith M. Wille
Tanveer Shaukat
Harkarandeep Singh
Andrew J. Admon
Matthew W. Semler
Miguel A. Hernán
Ariel L. Mueller
Wei Wang
David E. Leaf
the STOP-COVID Investigators
Publikationsdatum: 02.02.2021
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: Intensive Care Medicine / Ausgabe 2/2021
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06331-9

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