期刊
INTENSIVE CARE MEDICINE
卷 47, 期 2, 页码 208-221出版社
SPRINGER
DOI: 10.1007/s00134-020-06331-9
关键词
COVID-19; VV-ECMO; Extracorporeal membrane oxygenation; Severe respiratory failure; ARDS; Mortality
资金
- National Institutes of Health [K08GM134220, R03AG060179, R01HL144566, R01DK125786, K23HL130648, R37 AI102634, F32DC017342, K23DK120811, K23HL143053]
Limited data on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from COVID-19 were examined in a multicenter cohort study. Findings suggest that ECMO may reduce mortality in select patients with severe respiratory failure from COVID-19.
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/FiO(2) < 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/FiO(2) 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/FiO(2) < 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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