Multi-institutional Analysis of 505 Patients With Coronavirus Disease-2019 Supported With Extracorporeal Membrane Oxygenation: Predictors of Survival.

Autor:	Hall CA; Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida., Jacobs JP; Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee. Electronic address: jeffreyjacobs@ufl.edu., Stammers AH; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee., St Louis JD; Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Augusta University, Augusta, Georgia., Hayanga JWA; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia., Firstenberg MS; St. Elizabeth Medical Center, Appleton, Wisconsin., Mongero LB; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee., Tesdahl EA; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee., Rajagopal K; University of Houston, Houston, Texas., Cheema FH; University of Houston, Houston, Texas; HCA Healthcare Research Institute, Nashville, Tennessee., Patel K; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee., Coley T; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee., Sestokas AK; Medical Department, SpecialtyCare, Inc, Nashville, Tennessee., Slepian MJ; University of Arizona, Tucson, Arizona., Badhwar V; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2022 Jul; Vol. 114 (1), pp. 61-68. Date of Electronic Publication: 2022 Feb 18.
DOI:	10.1016/j.athoracsur.2022.01.043
Abstrakt:	Background: We reviewed our experience with 505 patients with confirmed coronavirus disease-2019 (COVID-19) supported with extracorporeal membrane oxygenation (ECMO) at 45 hospitals and estimated risk factors for mortality. Methods: A multi-institutional database was created and used to assess all patients with COVID-19 who were supported with ECMO. A Bayesian mixed-effects logistic regression model was estimated to assess the effect on survival of multiple potential risk factors for mortality, including age at cannulation for ECMO as well as days between diagnosis of COVID-19 and intubation and days between intubation and cannulation for ECMO. Results: Median time on ECMO was 18 days (interquartile range, 10-29 days). All 505 patients separated from ECMO: 194 patients (38.4%) survived and 311 patients (61.6%) died. Survival with venovenous ECMO was 184 of 466 patients (39.5%), and survival with venoarterial ECMO was 8 of 30 patients (26.7%). Survivors had lower median age (44 vs 51 years, P < .001) and shorter median time interval from diagnosis to intubation (7 vs 11 days, P = .001). Adjusting for several confounding factors, we estimated that an ECMO patient intubated on day 14 after the diagnosis of COVID-19 vs day 4 had a relative odds of survival of 0.65 (95% credible interval, 0.44-0.96; posterior probability of negative effect, 98.5%). Age was also negatively associated with survival: relative to a 38-year-old patient, we estimated that a 57-year-old patient had a relative odds of survival of 0.43 (95% credible interval, 0.30-0.61; posterior probability of negative effect, >99.99%). Conclusions: ECMO facilitates salvage and survival of select critically ill patients with COVID-19. Survivors tend to be younger and have shorter time from diagnosis to intubation. Survival of patients supported with only venovenous ECMO was 39.5%. (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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