Venovenous extracorporeal membrane oxygenation in patients with acute covid-19 associated respiratory failure: comparative effectiveness study. (4th May 2022)

• Record Type: Journal Article
• Authors: Urner, Martin; Barnett, Adrian G; Bassi, Gianluigi Li; Brodie, Daniel; Dalton, Heidi J; Ferguson, Niall D; Heinsar, Silver; Hodgson, Carol L; Peek, Giles; Shekar, Kiran; Suen, Jacky Y; Fraser, John F; Fan, Eddy
• Other Names: author non-byline.; Al-Dabbous Tala author non-byline.; Alfoudri Huda author non-byline.; Elapavaluru Subbarao author non-byline.; Berg Ashley author non-byline.; Horn Christina author non-byline.; Schroll Stephan author non-byline.; Velazco Jorge author non-byline.; Fikes Wanda author non-byline.; Ploskanych Ludmyla author non-byline.; Meyer Dan author non-byline.; Shalabi-McGuire Maysoon author non-byline.; Witt Trent author non-byline.; Ehlers Ashley author non-byline.; Grazioli Lorenzo author non-byline.; Grandin E Wilson author non-byline.; Nunez Jose author non-byline.; Reyes Tiago author non-byline.; Joseph Mark author non-byline.; Mitchell Brook author non-byline.; Tenzer Martha author non-byline.; Abe Ryuzo author non-byline.; Hayashi Yosuke author non-byline.; Cho Hwa Jin author non-byline.; Jeong In Seok author non-byline.; Brozzi Nicolas author non-byline.; Hernandez-Montfort Jaime author non-byline.; Mehkri Omar author non-byline.; Houltham Stuart author non-byline.; Graf Jerónimo author non-byline.; Perez Rodrigo author non-byline.; Diaz Roderigo author non-byline.; Delgado Camila author non-byline.; González Joyce author non-byline.; Sanchez Maria Soledad author non-byline.; Rincón Diego Fernando Bautista author non-byline.; Duque Melissa Bustamante author non-byline.; Marulanda Yanten Angela Maria author non-byline.; Rusmawatiningtyas Desy author non-byline.; Ragazzo Gabrielle author non-byline.; Taufik Azhari author non-byline.; Gunawan Margaretha author non-byline.; Irawany Vera author non-byline.; Rayhan Muhammad author non-byline.; Wardoyo Elizabeth Yasmin author non-byline.; Panigada Mauro author non-byline.; Coppola Silvia author non-byline.; Colombo Sebastiano author non-byline.; Grasselli Giacomo author non-byline.; Leone Michela author non-byline.; Zanella Alberto author non-byline.; Antonelli Massimo author non-byline.; Carelli Simone author non-byline.; Grieco Domenico author non-byline.; Asaki Motohiro author non-byline.; Hoshino Kota author non-byline.; Salazar Leonardo author non-byline.; Duarte Laura author non-byline.; McCaffrey Joseph author non-byline.; Bone Allison author non-byline.; Thomson David author non-byline.; Arnold-Day Christel author non-byline.; Cupido Jerome author non-byline.; Fanie Zainap author non-byline.; Miller Malcom author non-byline.; Seymore Lisa author non-byline.; van Straaten Dawid author non-byline.; Hassan Ibrahim author non-byline.; Hssain Ali Ait author non-byline.; Aliudin Jeffrey author non-byline.; Alqahtani Al-Reem author non-byline.; Mohamed Khoulod author non-byline.; Mohamed Ahmed author non-byline.; Tan Darwin author non-byline.; Villanueva Joy author non-byline.; Zaqout Ahmed author non-byline.; Kurtzman Ethan author non-byline.; Ademi Arben author non-byline.; Dobrita Ana author non-byline.; El Aoudi Khadija author non-byline.; Segura Juliet author non-byline.; Giwangkancana Gezy author non-byline.; Ohshimo Shinichiro author non-byline.; Hoshino Koji author non-byline.; Hitoshi Saito author non-byline.; Uchinami Yuka author non-byline.; Osatnik Javier author non-byline.; Joosten Anne author non-byline.; Torres Antoni author non-byline.; Motos Ana author non-byline.; Yang Minlan author non-byline.; Luna Carlos author non-byline.; Arancibia Francisco author non-byline.; Williams Virginie author non-byline.; Noel Alexandre author non-byline.; Luque Nestor author non-byline.; Trung Trieu Huynh author non-byline.; Yacoub Sophie author non-byline.; Fantini Marina author non-byline.; Jorge García Ruth Noemi author non-byline.; Alvarez Enrique Chicote author non-byline.; Greti Anna author non-byline.; Lomeli Oscar author non-byline.; Ceccato Adrian author non-byline.; Sanchez Angel author non-byline.; Vazquez Ana Loza author non-byline.; Roche-Campo Ferran author non-byline.; Tuazon Divina author non-byline.; Duculan Toni author non-byline.; Shimizu Hiroaki author non-byline.; Amato Marcelo author non-byline.; Cassimiro Luciana author non-byline.; Pola Flavio author non-byline.; Ribeiro Francis author non-byline.; Fonseca Guilherme author non-byline.; Desai Mehul author non-byline.; Osborn Erik author non-byline.; Deeb Hala author non-byline.; Arcadipane Antonio author non-byline.; Bianco Claudia author non-byline.; Cuffaro Raffaele author non-byline.; Martucci Gennaro author non-byline.; Occhipinti Giovanna author non-byline.; Rossetti Matteo author non-byline.; Vitiello Chiara author non-byline.; Cho Sung-Min author non-byline.; Calligy Kate author non-byline.; Whitman Glenn author non-byline.; Moriyama Naoki author non-byline.; Kim Jae-Burm author non-byline.; Kitamura Nobuya author non-byline.; Shimazui Takashi author non-byline.; Al-Hudaib Abdullah author non-byline.; Elhazmi Alyaa author non-byline.; Gebauer Johannes author non-byline.; Yokoyama Toshiki author non-byline.; Al-Fares Abdulrahman author non-byline.; Alamad Esam author non-byline.; Alawadhi Fatma author non-byline.; Alawadi Kalthoum author non-byline.; Buabbas Sarah author non-byline.; Tanaka Hiro author non-byline.; Hashimoto Satoru author non-byline.; Yamazaki Masaki author non-byline.; Oh Tak-Hyuck author non-byline.; Epler Mark author non-byline.; Forney Cathleen author non-byline.; Feister Jared author non-byline.; Grobengieser Katherine author non-byline.; Kruse Louise author non-byline.; Williamson Joelle author non-byline.; Gnall Eric author non-byline.; Caroline Mara author non-byline.; Golden Sasha author non-byline.; Karaj Colleen author non-byline.; McDermott Sherry author non-byline.; Sher Lynn author non-byline.; Shapiro Timothy author non-byline.; Thome Lisa author non-byline.; Vanderland Mark author non-byline.; Welch Mary author non-byline.; Brazzi Luca author non-byline.; Ogston Tawnya author non-byline.; Nagpal Dave author non-byline.; Fischer Karlee author non-byline.; Lorusso Roberto author non-byline.; de Piero Maria author non-byline.; Esperatti Mariano author non-byline.; O'Briain Diarmuid author non-byline.; Carton Edmund G author non-byline.; Sen Ayan author non-byline.; Palacios Amanda author non-byline.; Rainey Deborah author non-byline.; Seefeldt Cassandra author non-byline.; Durham Lucia author non-byline.; Falcucci Octavio author non-byline.; Emmrich Amanda author non-byline.; Guy Jennifer author non-byline.; Johns Carling author non-byline.; Neumann Emily author non-byline.; Buchtele Nina author non-byline.; Schwameis Michael author non-byline.; Stecher Stephanie-Susanne author non-byline.; Singh Delila author non-byline.; Barnikel Michaela author non-byline.; Arenz Lukas author non-byline.; Zaaqoq Akram author non-byline.; Galloway Lan Anh author non-byline.; Merley Caitlin author non-byline.; Csete Marc author non-byline.; Quesada Luisa author non-byline.; Saba Isabela author non-byline.; Kasugai Daisuke author non-byline.; Hiraiwa Hiroaki author non-byline.; Tanaka Taku author non-byline.; Marwali Eva author non-byline.; Chen Yih-Sharng author non-byline.; Laffey John author non-byline.; VanDyk Marlice author non-byline.; MacDonald Sarah author non-byline.; Seppelt Ian author non-byline.; Ratsep Indrek author non-byline.; Enneveer Lauri author non-byline.; Erikson Kristo author non-byline.; Oigus Getter author non-byline.; Post Andra-Maris author non-byline.; Sillaots Piret author non-byline.; Mihelis Effe author non-byline.; Komats Mamoru author non-byline.; Satyapriya S Veena author non-byline.; Bhatt Amar author non-byline.; Echeverria Marco author non-byline.; Fiorda Juan author non-byline.; Gonzalez Alicia author non-byline.; Mokadam Nahush A author non-byline.; McKeown Johnny author non-byline.; Pasek Joshua author non-byline.; Shi Haixia author non-byline.; Uribe Alberto author non-byline.; Moreno Rita author non-byline.; Zakhary Bishoy author non-byline.; Johnson Hannah author non-byline.; Pow Nolan author non-byline.; Cavana Marco author non-byline.; Cucino Alberto author non-byline.; Foti Giuseppe author non-byline.; Giani Marco author non-byline.; Russotto Vincenzo author non-byline.; Chiumello Davide author non-byline.; Castagna Valentina author non-byline.; Dell'Amore Andrea author non-byline.; Shum Hoi-Ping author non-byline.; Vuysteke Alain author non-byline.; Usman Asad author non-byline.; Acker Andrew author non-byline.; Mergler Blake author non-byline.; Rizer Nicolas author non-byline.; Sertic Federico author non-byline.; Smood Benjamin author non-byline.; Sperry Alexandra author non-byline.; Subramanian Madhu author non-byline.; Lolong Navy author non-byline.; Akmal Ernita author non-byline.; Burhan Erlina author non-byline.; Rasmin Menaldi author non-byline.; Naivedh Bhat author non-byline.; Barrett Peter author non-byline.; Daugherty Julia author non-byline.; Dean David author non-byline.; Loforte Antonio author non-byline.; Khan Irfan author non-byline.; DeSantis Olivia author non-byline.; Quraishi Mohammed Abraar author non-byline.; Salt Gavin author non-byline.; So Dominic author non-byline.; Kandamby Darshana author non-byline.; Mandei Jose M author non-byline.; Natanael Hans author non-byline.; Lantang Eka Yudha author non-byline.; Lantang Anastasia author non-byline.; Jung Anna author non-byline.; Hammond Terese author non-byline.; Ng George author non-byline.; Ng Wing Yiu author non-byline.; Yeung Pauline author non-byline.; Adachi Shingo author non-byline.; Blanco Pablo author non-byline.; Prieto Ana author non-byline.; Sánchez Jesús author non-byline.; Nicholson Meghan author non-byline.; Farquharson Michael author non-byline.; Butt Warwick author non-byline.; Serratore Alyssa author non-byline.; Delzoppo Carmel author non-byline.; Janin Pierre author non-byline.; Yarad Elizabeth author non-byline.; Totaro Richard author non-byline.; Coles Jennifer author non-byline.; Balk Robert author non-byline.; Fox Samuel author non-byline.; Hays James author non-byline.; Kapania Esha author non-byline.; Mishin Pavel author non-byline.; Vissing Andy author non-byline.; Yantosh Garrett author non-byline.; Yuliarito Saptadi author non-byline.; Santoso Kohar Hari author non-byline.; Djajalaksana Susanthy author non-byline.; Fatoni Arie Zainul author non-byline.; Fukuda Masahiro author non-byline.; Liu Keibun author non-byline.; Pelosi Paolo author non-byline.; Battaglini Denise author non-byline.; Jiménez Juan Fernando Masa author non-byline.; Gaião Sérgio author non-byline.; Roncon-Albuquerque Roberto author non-byline.; Buchner Jessica author non-byline.; Cho Young-Jae author non-byline.; Lee Sang Min author non-byline.; Lee Su Hwan author non-byline.; Kawasaki Tatsuya author non-byline.; Sakiyalak Pranya author non-byline.; Nitayavardhana Prompak author non-byline.; Seitz Tamara author non-byline.; Arora Rakesh author non-byline.; Kent David author non-byline.; Parwar Swapnil author non-byline.; Cheng Andrew author non-byline.; Miller Jennene author non-byline.; Marino Daniel author non-byline.; Deacon Jillian E author non-byline.; Fujitani Shigeki author non-byline.; Shimizu Naoki author non-byline.; Madhok Jai author non-byline.; Owyang Clark author non-byline.; Buscher Hergen author non-byline.; Reynolds Claire author non-byline.; Maasikas Olavi author non-byline.; Beljantsev Aleksandr author non-byline.; Mihnovits Vladislav author non-byline.; Akimoto Takako author non-byline.; Aizawa Mariko author non-byline.; Horibe Kanako author non-byline.; Onodera Ryota author non-byline.; Young Meredith author non-byline.; Smith Timothy author non-byline.; Bartone Cheryl author non-byline.; George Timothy author non-byline.; Shekar Kiran author non-byline.; McGuinness Niki author non-byline.; Irvine Lacey author non-byline.; Flynn Brigid author non-byline.; Houchin Abigail author non-byline.; Shimizu Keiki author non-byline.; Hamaguchi Jun author non-byline.; Lussier Leslie author non-byline.; Kersker Grace author non-byline.; Reich John Adam author non-byline.; Lotz Gösta author non-byline.; Malfertheiner Maximilian author non-byline.; Dreier Esther author non-byline.; Maier Lars author non-byline.; Kusumastuti Neurinda Permata author non-byline.; McCloskey Colin author non-byline.; Dabaliz Al-Awwab author non-byline.; Elshazly Tarek B author non-byline.; Smith Josiah author non-byline.; Szuldrzynski Konstanty S author non-byline.; Bielański Piotr author non-byline.; Hakeem Yusuff author non-byline.; Wille Keith author non-byline.; Holt Rebecca author non-byline.; Parhar Ken Kuljit S author non-byline.; Fiest Kirsten M author non-byline.; Codan Cassidy author non-byline.; Shahid Anmol author non-byline.; Fayed Mohamed author non-byline.; Evans Timothy author non-byline.; Garcia Rebekah author non-byline.; Gutierrez Ashley author non-byline.; Song Tae author non-byline.; Rose Rebecca author non-byline.; Bennett Suzanne author non-byline.; Richardson Denise author non-byline.; Lopez-Colon Dalia author non-byline.; Arora Lovkesh author non-byline.; Rappapport Kristina author non-byline.; Rudolph Kristina author non-byline.; Sibenaller Zita author non-byline.; Stout Lori author non-byline.; Walter Alicia author non-byline.; Herr Daniel author non-byline.; Vedadi Nazli author non-byline.; Sindt Lace author non-byline.; Ewald Cale author non-byline.; Hoffman Julie author non-byline.; Rajnic Sean author non-byline.; Thompson Shaun author non-byline.; Kennedy Ryan author non-byline.; Griffee Matthew author non-byline.; Ciullo Anna author non-byline.; Kida Yuri author non-byline.; Roca Ricard Ferrer author non-byline.; Alegre Cynthia author non-byline.; Contreras Sofia author non-byline.; Riera Jordi author non-byline.; Kay Christy author non-byline.; Fischer Irene author non-byline.; Renner Elizabeth author non-byline.; Taniguci Hayato author non-byline.; Abbate Gabriella author non-byline.; Hassan Halah author non-byline.; Karnik Varun A author non-byline.; Ki Katrina author non-byline.; O'Neill Hollier F author non-byline.; Obonyo Nchafatso author non-byline.; Pimenta Leticia Pretti author non-byline.; Reid Janice D author non-byline.; Sato Kei author non-byline.; Vuorinen Aapeli author non-byline.; Wildi Karin S author non-byline.; Wood Emily S author non-byline.; Yerkovich Stephanie author non-byline.;
• Is Part Of: BMJ. Volume 377(2022)
• Publication Date: 2022-05-04
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj-2021-068723
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To estimate the effect of extracorporeal membrane oxygenation (ECMO) compared with conventional mechanical ventilation on outcomes of patients with covid-19 associated respiratory failure. Design: Observational study. Setting: 30 countries across five continents, 3 January 2020 to 29 August 2021. Participants: 7345 adults admitted to the intensive care unit with clinically suspected or laboratory confirmed SARS-CoV-2 infection. Interventions: ECMO in patients with a partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2 /FiO2 ) ratio <80 mm Hg compared with conventional mechanical ventilation without ECMO. Main outcome measure: The primary outcome was hospital mortality within 60 days of admission to the intensive care unit. Adherence adjusted estimates were calculated using marginal structural models with inverse probability weighting, accounting for competing events and for baseline and time varying confounding. Results: 844 of 7345 eligible patients (11.5%) received ECMO at any time point during follow-up. Adherence adjusted mortality was 26.0% (95% confidence interval 24.5% to 27.5%) for a treatment strategy that included ECMO if the PaO2 /FiO2 ratio decreased <80 mm Hg compared with 33.2% (31.8% to 34.6%) had patients received conventional treatment without ECMO (risk difference –7.1%, 95% confidence interval –8.2% to –6.1%; risk ratio 0.78, 95% confidence interval 0.75 to 0.82). In secondary analyses, ECMO was most effective in patients aged <65 years and with a PaO2 /FiO2 <80 mm Hg or with driving pressures >15 cmH2 O during the first 10 days of mechanical ventilation. Conclusions: ECMO was associated with a reduction in mortality in selected adults with covid-19 associated respiratory failure. Age, severity of hypoxaemia, and duration and intensity of mechanical ventilation were found to be modifiers of treatment effectiveness and should be considered when deciding to initiate ECMO in patients with covid-19.