TY - JOUR
T1 - Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19
AU - on behalf of the STOP-COVID Investigators
AU - Shaefi, Shahzad
AU - Brenner, Samantha K.
AU - Gupta, Shruti
AU - O’Gara, Brian P.
AU - Krajewski, Megan L.
AU - Charytan, David M.
AU - Chaudhry, Sobaata
AU - Mirza, Sara H.
AU - Peev, Vasil
AU - Anderson, Mark
AU - Bansal, Anip
AU - Hayek, Salim S.
AU - Srivastava, Anand
AU - Mathews, Kusum S.
AU - Johns, Tanya S.
AU - Leonberg-Yoo, Amanda
AU - Green, Adam
AU - Arunthamakun, Justin
AU - Wille, Keith M.
AU - Shaukat, Tanveer
AU - Singh, Harkarandeep
AU - Admon, Andrew J.
AU - Semler, Matthew W.
AU - Hernán, Miguel A.
AU - Mueller, Ariel L.
AU - Wang, Wei
AU - Leaf, David E.
AU - Walther, Carl P.
AU - Anumudu, Samaya J.
AU - Kopecky, Kathleen F.
AU - Milligan, Gregory P.
AU - McCullough, Peter A.
AU - Nguyen, Thuy Duyen
AU - Shaefi, Shahzad
AU - Baskin, Sean M.
AU - Shankar, Sidharth
AU - Valencia, Juan D.
AU - Pannu, Ameeka
AU - Hayes, Margaret M.
AU - Grandin, E. Wilson
AU - Waikar, Sushrut S.
AU - Kibbelaar, Zoe A.
AU - Athavale, Ambarish M.
AU - Hart, Peter
AU - Upadhyay, Shristi
AU - Vohra, Ishaan
AU - Oyintayo, Ajiboye
AU - Rachoin, Jean Sebastien
AU - Kruser, Jacqueline M.
AU - Wunderink, Richard G.
N1 - Funding Information:
DEL received research support from BioPorto outside the submitted work. DMC reports grants and personal fees from NovoNordisk, personal fees from PLC medical, grants from Bioporto, personal fees from Fresenius, personal fees from AstraZeneca, grants and personal fees from Jannssen, grants and personal fees from Gilead, and personal fees from Merck, all outside the submitted work. AS reports personal fees from Horizon Therapeutics PLC, AstraZeneca, and CVS Caremark. SG is a scientific coordinator for the ASCEND trial (GlaskoSmithKline), outside the submitted work. KSM reports serving on the BREATHE Trial Steering Committee, funded by Roivant/Kinevant Sciences, outside the submitted work. BOG receives consulting fees from Sedana Medical outside the submitted work. The authors of the writing committee are supported by the following grants from the National Institutes of Health: K08GM134220 and R03AG060179 (SS); R01HL144566 and R01DK125786 (DEL); K23HL130648 (KSM); R37 AI102634 (MAH); F32DC017342 (SG); K23DK120811 (AS); K23HL143053 (MWS).
Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
KW - ARDS
KW - COVID-19
KW - Extracorporeal membrane oxygenation
KW - Mortality
KW - Severe respiratory failure
KW - VV-ECMO
UR - http://www.scopus.com/inward/record.url?scp=85100423760&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100423760&partnerID=8YFLogxK
U2 - 10.1007/s00134-020-06331-9
DO - 10.1007/s00134-020-06331-9
M3 - Article
C2 - 33528595
AN - SCOPUS:85100423760
SN - 0342-4642
VL - 47
SP - 208
EP - 221
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 2
ER -
