Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry.

Autor:	Barbaro RP; Division of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA. Electronic address: barbaror@med.umich.edu., MacLaren G; Cardiothoracic Intensive Care Unit, National University Health System, Singapore., Boonstra PS; School of Public Health Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA., Iwashyna TJ; Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA., Slutsky AS; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada., Fan E; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada., Bartlett RH; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Tonna JE; Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, UT, USA., Hyslop R; Heart Institute, Children's Hospital Colorado, Aurora, CO, USA., Fanning JJ; Medical City Children's Hospital, Dallas, TX, USA., Rycus PT; Extracorporeal Life Support Organization, Ann Arbor, MI, USA., Hyer SJ; Extracorporeal Life Support Organization, Ann Arbor, MI, USA., Anders MM; Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA., Agerstrand CL; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA., Hryniewicz K; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA., Diaz R; Clinica Las Condes, Santiago, Chile., Lorusso R; Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands., Combes A; Sorbonne University, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris Sorbonne Hôpital Pitié-Salpêtrière, Paris, France., Brodie D; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Lancet (London, England) [Lancet] 2020 Oct 10; Vol. 396 (10257), pp. 1071-1078. Date of Electronic Publication: 2020 Sep 25.
DOI:	10.1016/S0140-6736(20)32008-0
Abstrakt:	Background: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. Methods: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality. Findings: Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4-40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20-2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6-41·5). Interpretation: In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19. Funding: None. (Copyright © 2020 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu