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

被引：268

作者：

Barbaro, Ryan P. ^{[1
]}

MacLaren, Graeme ^{[3
]}

Boonstra, Philip S. ^{[2
]}

Combes, Alain ^{[4
,5
]}

Agerstrand, Cara ^{[6
,7
]}

Annich, Gail ^{[8
]}

Diaz, Rodrigo ^{[9
]}

Fan, Eddy ^{[10
]}

Hryniewicz, Katarzyna ^{[11
]}

Lorusso, Roberto ^{[12
]}

Paden, Matthew L. ^{[13
,14
]}

Stead, Christine M. ^{[15
]}

Swol, Justyna ^{[16
]}

Iwashyna, Theodore J. ^{[17
,18
]}

Slutsky, Arthur S. ^{[10
,19
]}

Brodie, Daniel ^{[6
,7
]}

机构：

[1] Univ Michigan, Sch Publ Hlth, Div Pediat Crit Care Med, Ann Arbor, MI 48109 USA

[2] Univ Michigan, Sch Publ Hlth, Dept Biostat, Ann Arbor, MI 48109 USA

[3] Natl Univ Hlth Syst, Dept Cardiac Thorac & Vasc Surg, Cardiothorac Intens Care Unit, Singapore, Singapore

[4] Sorbonne Univ, Inst Cardiometab & Nutr, INSERM, UMRS1166,ICAN, Paris, France

[5] Sorbonne Hop Pitie Salpetriere, APHP, Inst Cardiol, Serv Med Intens Reanimat, Paris, France

[6] Columbia Univ Coll Phys & Surg, Div Pulm Allergy & Crit Care Med, 630 W 168th St, New York, NY 10032 USA

[7] New York Presbyterian Hosp, Ctr Acute Resp Failure, New York, NY USA

[8] Hosp Sick Children, Dept Crit Care Med, Toronto, ON, Canada

[9] Clin Las Condes, Santiago, Chile

[10] Univ Toronto, Interdept Div Crit Care, Toronto, ON, Canada

[11] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA

[12] Maastricht Univ, Med Ctr, Cardiovasc Res Inst Maastricht, Dept Cardiothorac Surg,Heart & Vasc Ctr, Maastricht, Netherlands

[13] Emory Univ, Div Pediat Crit Care, Atlanta, GA 30322 USA

[14] Childrens Healthcare Atlanta, Atlanta, GA USA

[15] Extracorporeal Life Support Org, Ann Arbor, MI USA

[16] Paracelsus Med Univ, Dept Pneumol Allergol & Sleep Med, Nurnberg, Germany

[17] Univ Michigan, Sch Med, Div Pulm & Crit Care Med, Ann Arbor, MI USA

[18] Vet Affairs Ctr Clin Management Res, Ann Arbor, MI USA

[19] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Ctr Biomed Res, Toronto, ON, Canada

来源：

LANCET | 2021年 / 398卷 / 10307期

基金：

美国国家卫生研究院;

关键词：

D O I：

10.1016/S0140-6736(21)01960-7

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 earlyadopting 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. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

引用

页码：1230 / 1238

页数：9

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