Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Issue 10257 (10th October 2020)

• Record Type: Journal Article
• Authors: Barbaro, Ryan P; MacLaren, Graeme; Boonstra, Philip S; Iwashyna, Theodore J; Slutsky, Arthur S; Fan, Eddy; Bartlett, Robert H; Tonna, Joseph E; Hyslop, Robert; Fanning, Jeffrey J; Rycus, Peter T; Hyer, Steve J; Anders, Marc M; Agerstrand, Cara L; Hryniewicz, Katarzyna; Diaz, Rodrigo; Lorusso, Roberto; Combes, Alain; Brodie, Daniel; Alexander, Peta; Barrett, Nicholas; Bělohlávek, Jan; Fisher, Dale; Fraser, John; Hssain, Ali Ait; Jung, Jae Sung; McMullan, Michael; Mehta, Yatin; Ogino, Mark T.; Paden, Matthew L.; Shekar, Kiran; Stead, Christine; Abu-Omar, Yasir; Agnoletti, Vanni; Akbar, Anzila; Alfoudri, Huda; Alviar, Carlos; Aronsky, Vladimir; August, Erin; Auzinger, Georg; Aveja, Hilda; Bakken, Rhonda; Balcells, Joan; Bangalore, Sripal; Barnes, Bernard W.; Bautista, Alaiza; Bellows, Lorraine L.; Beltran, Felipe; Benharash, Peyman; Benni, Marco; Berg, Jennifer; Bertini, Pietro; Blanco-Schweizer, Pablo; Brunsvold, Melissa; Budd, Jenny; Camp, Debra; Caridi-Scheible, Mark; Carton, Edmund; Casanova-Ghosh, Elena; Castleberry, Anthony; Chipongian, Christopher T.; Choi, Chang Woo; Circelli, Alessandro; Cohen, Elliott; Collins, Michael; Copus, Scott; Coy, Jill; Crist, Brandon; Cruz, Leonora; Czuczwar, Mirosław; Daneshmand, Mani; Davis II, Daniel; De la Cruz, Kim; Devers, Cyndie; Duculan, Toni; Durham, Lucian; Elapavaluru, Subbarao; Elzo Kraemer, Carlos V.; Filho, EDMÍLSON CARDOSO; Fitzgerald, Jillian; Foti, Giuseppe; Fox, Matthew; Fritschen, David; Fullerton, David; Gelandt, Elton; Gerle, Stacy; Giani, Marco; Goh, Si Guim; Govener, Sara; Grone, Julie; Guber, Miles; Gudzenko, Vadim; Gutteridge, Daniel; Guy, Jennifer; Haft, Jonathan; Hall, Cameron; Hassan, Ibrahim Fawzy; Herrán, Rubén; Hirose, Hitoshi; Ibrahim, Abdulsalam Saif; Igielski, Don; Ivascu, Felicia A.; Izquierdo Blasco, Jaume; Jackson, Julie; Jain, Harsh; Jaiswal, Bhavini; Johnson, Andrea C.; Jurynec, Jenniver A.; Kellter, Norma M; Kohl, Adam; Kon, Zachary; Kredel, Markus; Kriska, Karen; Kunavarapu, Chandra; Lansink-Hartgring, Oude; LaRocque, Jeliene; Larson, Sharon Beth; Layne, Tracie; Ledot, Stephane; Lena, Napolitan; Lillie, Jonathan; Lotz, Gösta; Lucas, Mark; Ludwigson, Lee; Maas, Jacinta J.; Maertens, Joanna; Mast, David; McCardle, Scott; McDonald, Bernard; McLarty, Allison; McMahon, Chelsea; Meybohm, Patrick; Meyns, Bart; Miller, Casey; Moraes Neto, Fernando; Morris, Kelly; Muellenbach, Ralf; Nicholson, Meghan; O'Brien, Serena; O'Keefe, Kathryn; Ogston, Tawnya; Oldenburg, Gary; Oliveira, Fabiana M.; Oppel, Emily; Pardo, Diego; Pardo, Diego; Parker, Sara J.; Pedersen, Finn M.; Pellecchia, Crescens; Pelligrini, Jose A.S.; Pham, Thao T.N.; Phillips, Ann R.; Pirani, Tasneem; Piwowarczyk, Paweł; Plambeck, Robert; Pruett, William; Quandt, Brittany; Ramanathan, Kollengode; Rey, Alejandro; Reyher, Christian; Riera del Brio, Jordi; Roberts, Rachel; Roe, David; Roeleveld, Peter P.; Rudy, Janet; Rueda, Luis F.; Russo, Emanuele; Sánchez Ballesteros, Jesús; Satou, Nancy; Saueressig, Mauricio Guidi; Saunders, Paul C.; Schlotterbeck, Margaret; Schwarz, Patricia; Scriven, Nicole; Serra, Alexis; Shamsah, Mohammad; Sim, Lucy; Smart, Alexandra; Smith, Adam; Smith, Deane; Smith, Maggie; Sodha, Neel; Sonntagbauer, Michael; Sorenson, Marc; Stallkamp, Eric B; Stewart, Allison; Swartz, Kathy; Takeda, Koji; Thompson, Shaun; Toy, Bridget; Tuazon, Divina; Uchiyama, Makoto; Udeozo, Obiora I.; van Poppel, Scott; Ventetuolo, Corey; Vercaemst, Leen; Vinh Chau, Nguyen V.; Wang, I-Wen; Williamson, Carrie; Wilson, Brock; Winkels, Helen;
• Is Part Of: Lancet. Volume 396:Issue 10257(2020)
• Page Start: 1071
• Page End: 1078
• Publication Date: 2020-10-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(20)32008-0
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: None.