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Intensive Care Medicine

Erschienen in:

03.03.2022 | COVID-19 | Original

Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study

verfasst von: Stephen Whebell, Joe Zhang, Rebecca Lewis, Michael Berry, Stephane Ledot, Andrew Retter, Luigi Camporota

Erschienen in: Intensive Care Medicine | Ausgabe 4/2022

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Abstract

Purpose

Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 (COVID-19). The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality.

Methods

A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques.

Results

1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29–0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre.

Conclusion

We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered.

Nur mit Berechtigung zugänglich

Falcoz P-E, Monnier A, Puyraveau M et al (2020) Extracorporeal membrane oxygenation for critically ill patients with COVID-19 related acute respiratory distress syndrome: worth the effort? Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.202004-1370LECrossRefPubMedPubMedCentral

Henry BM, Lippi G (2020) Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): pooled analysis of early reports. J Crit Care 58:27–28. https://doi.org/10.1016/j.jcrc.2020.03.011CrossRefPubMedPubMedCentral

Lebreton G, Schmidt M, Ponnaiah M et al (2021) Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study. Lancet Respir Med 9:851–862. https://doi.org/10.1016/S2213-2600(21)00096-5CrossRefPubMedPubMedCentral

Karagiannidis C, Slutsky AS, Bein T et al (2021) Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic. Crit Care 25:413. https://doi.org/10.1186/s13054-021-03831-yCrossRefPubMedPubMedCentral

Schmidt M, Hajage D, Lebreton G et al (2020) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. https://doi.org/10.1016/S2213-2600(20)30328-3CrossRefPubMedPubMedCentral

Zhang J, Merrick B, Correa GL et al (2020) Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series. ERJ Open Research. https://doi.org/10.1183/23120541.00463-2020CrossRefPubMedPubMedCentral

Ramanathan K, Shekar K, Ling RR et al (2021) Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care 25:211. https://doi.org/10.1186/s13054-021-03634-1CrossRefPubMedPubMedCentral

Bellani G, Laffey JG, Pham T et al (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788. https://doi.org/10.1001/jama.2016.0291CrossRefPubMed

Shekar K, Badulak J, Peek G et al (2020) Extracorporeal life support organization coronavirus disease 2019 interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers. ASAIO J 66:707–721. https://doi.org/10.1097/MAT.0000000000001193CrossRefPubMed

10.

Badulak J, Antonini MV, Stead CM et al (2021) Extracorporeal membrane oxygenation for COVID-19: updated 2021 guidelines from the extracorporeal life support organization. ASAIO J 67:485–495. https://doi.org/10.1097/MAT.0000000000001422CrossRefPubMedPubMedCentral

11.

Fang J, Li R, Chen Y et al (2021) Extracorporeal membrane oxygenation therapy for critically ill coronavirus disease 2019 patients in Wuhan, China: a retrospective multicenter cohort study. Curr Med Sci 41:1–13. https://doi.org/10.1007/s11596-021-2311-8CrossRefPubMedPubMedCentral

12.

The STOP-COVID Investigators, Shaefi S, Brenner SK et al (2021) Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19. Intensive Care Med 47:208–221. https://doi.org/10.1007/s00134-020-06331-9CrossRef

13.

Haiduc AA, Alom S, Melamed N, Harky A (2020) Role of extracorporeal membrane oxygenation in COVID-19: a systematic review. J Card Surg 35:2679–2687. https://doi.org/10.1111/jocs.14879CrossRefPubMed

14.

NHS England (2020) Clinical guide for extra corporeal membrane oxygenation (ECMO) for respiratory failure in adults during the coronavirus pandemic. https://warwick.ac.uk/fac/sci/med/research/ctu/trials/recovery-rs/news/speciality-guide-extra-corporealmembrane-oxygenation-ecmo-adult.pdf

15.

Camporota L, Meadows C, Ledot S et al (2021) Consensus on the referral and admission of patients with severe respiratory failure to the NHS ECMO service. Lancet Respir Med 9:e16–e17. https://doi.org/10.1016/S2213-2600(20)30581-6CrossRefPubMedPubMedCentral

16.

Czapran A, Steel M, Barrett NA (2020) Extra-corporeal membrane oxygenation for severe respiratory failure in the UK. J Intensive Care Soc 21:247–255. https://doi.org/10.1177/1751143719870082CrossRefPubMed

17.

NHS England (2019) Adult ECMO service specification. https://www.england.nhs.uk/wp-content/uploads/2019/02/Adult-ECMO-Service-Specification.pdf

18.

Peek GJ, Mugford M, Tiruvoipati R et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351. https://doi.org/10.1016/S0140-6736(09)61069-2CrossRefPubMed

19.

Stekhoven DJ, Buhlmann P (2012) MissForest—non-parametric missing value imputation for mixed-type data. Bioinformatics 28:112–118. https://doi.org/10.1093/bioinformatics/btr597CrossRefPubMed

20.

Franchetti Y (2021) Use of propensity scoring and its application to real world data: advantages, disadvantages, and methodological objectives explained to researchers without using mathematical equations. J Clin Pharmacol. https://doi.org/10.1002/jcph.1989CrossRefPubMed

21.

Diamond A, Sekhon JS (2013) Genetic matching for estimating causal effects: a general multivariate matching method for achieving balance in observational studies. Rev Econ Stat 95:932–945. https://doi.org/10.1162/REST_a_00318CrossRef

22.

Written on Behalf of AME Big-Data Clinical Trial Collaborative Group, Zhang Z, Kim HJ et al (2019) Balance diagnostics after propensity score matching. Ann Transl Med 7:16–16. https://doi.org/10.21037/atm.2018.12.10CrossRefPubMedCentral

23.

VanderWeele TJ, Ding P (2017) Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med 167:268–274. https://doi.org/10.7326/M16-2607CrossRefPubMed

24.

Mathur MB, Ding P, Riddell CA, VanderWeele TJ (2018) Web site and R package for computing E-values. Epidemiology 29:e45–e47. https://doi.org/10.1097/EDE.0000000000000864CrossRefPubMedPubMedCentral

25.

Ho DE, Imai K, King G, Stuart EA (2011) MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Soft. https://doi.org/10.18637/jss.v042.i08CrossRef

26.

Barbaro RP, MacLaren G, Boonstra PS et al (2020) Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet 396:1071–1078. https://doi.org/10.1016/S0140-6736(20)32008-0CrossRefPubMedPubMedCentral

27.

Combes A, Hajage D, Capellier G et al (2018) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 378:1965–1975. https://doi.org/10.1056/NEJMoa1800385CrossRefPubMed

28.

Gattinoni L, Vasques F, Quintel M (2018) Use of ECMO in ARDS: does the EOLIA trial really help? Crit Care 22:171. https://doi.org/10.1186/s13054-018-2098-6CrossRefPubMedPubMedCentral

29.

Sameed M, Meng Z, Marciniak ET (2019) EOLIA trial: the future of extracorporeal membrane oxygenation in acute respiratory distress syndrome therapy? Breathe 15:244–246. https://doi.org/10.1183/20734735.0363-2018CrossRefPubMedPubMedCentral

30.

Barbaro RP, MacLaren G, Boonstra PS et al (2021) Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry. The Lancet 398:1230–1238. https://doi.org/10.1016/S0140-6736(21)01960-7CrossRef

31.

Riera J, Roncon-Albuquerque R, Fuset MP et al (2021) Increased mortality in patients with COVID-19 receiving extracorporeal respiratory support during the second wave of the pandemic. Intensive Care Med. https://doi.org/10.1007/s00134-021-06517-9CrossRefPubMedPubMedCentral

32.

Riera J, Alcántara S, Bonilla C et al (2021) Risk factors for mortality in patients with COVID-19 needing extracorporeal respiratory support. Eur Respir J. https://doi.org/10.1183/13993003.02463-2021CrossRef

33.

Pham T, Combes A, Rozé H et al (2013) Extracorporeal membrane oxygenation for pandemic influenza A (H1N1)–induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med 187:276–285. https://doi.org/10.1164/rccm.201205-0815OCCrossRefPubMed

34.

Noah MA, Peek GJ, Finney SJ et al (2011) Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A (H1N1). JAMA 306:1659. https://doi.org/10.1001/jama.2011.1471CrossRefPubMed

35.

Zhang J, Whebell SF, Sanderson B et al (2021) Phenotypes of severe COVID-19 ARDS receiving extracorporeal membrane oxygenation. Br J Anaesth 126:e130–e132. https://doi.org/10.1016/j.bja.2020.12.023CrossRefPubMed

36.

Azoulay E, Zafrani L, Mirouse A et al (2020) Clinical phenotypes of critically ill COVID-19 patients. Intensive Care Med 46:1651–1652. https://doi.org/10.1007/s00134-020-06120-4CrossRefPubMedPubMedCentral

37.

Bottle A, Faitna P, Aylin PP (2021) Patient-level and hospital-level variation and related time trends in COVID-19 case fatality rates during the first pandemic wave in England: multilevel modelling analysis of routine data. BMJ Qual Saf. https://doi.org/10.1136/bmjqs-2021-012990CrossRefPubMedPubMedCentral

38.

Gray WK, Navaratnam AV, Day J et al (2021) Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: a national observational study for the Getting It Right First Time Programme. EClinicalMedicine 35:100859. https://doi.org/10.1016/j.eclinm.2021.100859CrossRefPubMedPubMedCentral

39.

NHS England (2021) Service specification for adult critical care transfer services. https://www.england.nhs.uk/wp-content/uploads/2021/06/Service-Specification-Adult-Critical-Care-Transfer-services.pdf

Titel: Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study
verfasst von: Stephen Whebell
Joe Zhang
Rebecca Lewis
Michael Berry
Stephane Ledot
Andrew Retter
Luigi Camporota
Publikationsdatum: 03.03.2022
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: Intensive Care Medicine / Ausgabe 4/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-022-06645-w

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Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study