Back to Search
Start Over
Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry.
- Source :
-
Lancet . 10/10/2020, Vol. 396 Issue 10257, p1071-1078. 8p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Findings: </bold>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).<bold>Interpretation: </bold>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.<bold>Funding: </bold>None. [ABSTRACT FROM AUTHOR]
- Subjects :
- *EXTRACORPOREAL membrane oxygenation
*COVID-19
*ADULT respiratory distress syndrome
*HOSPITAL mortality
*COHORT analysis
*CORONAVIRUS disease treatment
*VIRAL pneumonia
*RESPIRATORY insufficiency
*ACQUISITION of data
*TREATMENT effectiveness
*EPIDEMICS
*HOSPITAL care
*CRITICAL care medicine
*RESEARCH funding
*LONGITUDINAL method
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 01406736
- Volume :
- 396
- Issue :
- 10257
- Database :
- Academic Search Index
- Journal :
- Lancet
- Publication Type :
- Academic Journal
- Accession number :
- 146347661
- Full Text :
- https://doi.org/10.1016/S0140-6736(20)32008-0