Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry,The Lancet

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Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry
The Lancet ( IF 98.4 ) Pub Date : 2021-09-29 , DOI: 10.1016/s0140-6736(21)01960-7
Ryan P Barbaro ₁ , Graeme MacLaren ₂ , Philip S Boonstra ₃ , Alain Combes ₄ , Cara Agerstrand ₅ , Gail Annich ₆ , Rodrigo Diaz ₇ , Eddy Fan ₈ , Katarzyna Hryniewicz ₉ , Roberto Lorusso ₁₀ , Matthew L Paden ₁₁ , Christine M Stead ₁₂ , Justyna Swol ₁₃ , Theodore J Iwashyna ₁₄ , Arthur S Slutsky ₁₅ , Daniel Brodie ₅ ,

Affiliation

Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health System, Singapore.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Sorbonne Université, INSERM, UMRS1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Sorbonne Hôpital Pitié-Salpêtrière, Paris, France.
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Clinica Las Condes, Santiago, Chile.
Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
Division of Pediatric Critical Care, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
Extracorporeal Life Support Organization, Ann Arbor, MI, USA.
Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany.
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.
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.

Background

Over the course of the COVID-19 pandemic, the care of patients with COVID-19 has changed and the use of extracorporeal membrane oxygenation (ECMO) has increased. We aimed to examine patient selection, treatments, outcomes, and ECMO centre characteristics over the course of the pandemic to date.

Methods

We retrospectively analysed the Extracorporeal Life Support Organization Registry and COVID-19 Addendum to compare three groups of ECMO-supported patients with COVID-19 (aged ≥16 years). At early-adopting centres—ie, those using ECMO support for COVID-19 throughout 2020—we compared patients who started ECMO on or before May 1, 2020 (group A1), and between May 2 and Dec 31, 2020 (group A2). Late-adopting centres were those that provided ECMO for COVID-19 only after May 1, 2020 (group B). The primary outcome was in-hospital mortality in a time-to-event analysis assessed 90 days after ECMO initiation. A Cox proportional hazards model was fit to compare the patient and centre-level adjusted relative risk of mortality among the groups.

Findings

In 2020, 4812 patients with COVID-19 received ECMO across 349 centres within 41 countries. For early-adopting centres, the cumulative incidence of in-hospital mortality 90 days after ECMO initiation was 36·9% (95% CI 34·1–39·7) in patients who started ECMO on or before May 1 (group A1) versus 51·9% (50·0–53·8) after May 1 (group A2); at late-adopting centres (group B), it was 58·9% (55·4–62·3). Relative to patients in group A2, group A1 patients had a lower adjusted relative risk of in-hospital mortality 90 days after ECMO (hazard ratio 0·82 [0·70−0·96]), whereas group B patients had a higher adjusted relative risk (1·42 [1·17−1·73]).

Interpretation

Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers.

Funding

None.

中文翻译：

COVID-19 的体外膜肺氧合：国际体外生命支持组织登记处不断演变的结果

背景

在 COVID-19 大流行期间，对 COVID-19 患者的护理发生了变化，体外膜肺氧合 (ECMO) 的使用有所增加。我们旨在检查迄今为止大流行期间的患者选择、治疗、结果和 ECMO 中心特征。

方法

我们回顾性分析了体外生命支持组织登记和 COVID-19 附录，以比较三组 ECMO 支持的 COVID-19 患者（年龄≥16 岁）。在早期采用中心——即那些在 2020 年全年使用 ECMO 支持 COVID-19 的中心——我们比较了在 2020 年 5 月 1 日或之前开始 ECMO 的患者（A1 组）和 2020 年 5 月 2 日至 12 月 31 日之间（A2 组） . 后期采用中心是那些仅在 2020 年 5 月 1 日之后才为 COVID-19 提供 ECMO 的中心（B 组）。在 ECMO 开始后 90 天评估的事件发生时间分析中，主要结果是院内死亡率。Cox 比例风险模型适合比较组间患者和中心水平调整后的相对死亡风险。

发现

2020 年，4812 名 COVID-19 患者在 41 个国家的 349 个中心接受了 ECMO。对于早期采用中心，在 5 月 1 日或之前开始 ECMO 的患者（A1 组）开始 ECMO 后 90 天的院内死亡率累积发生率为 36·9%（95% CI 34·1-39·7）与 5 月 1 日之后的 51·9% (50·0–53·8) 相比（A2 组）；在晚收养中心（B 组），这一比例为 58·9%（55·4–62·3）。相对于 A2 组患者，A1 组患者在 ECMO 后 90 天的院内死亡率校正相对风险较低（风险比 0·82 [0·70-0·96]），而 B 组患者的校正后相对风险较高相对风险（1·42 [1·17−1·73]）。