Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19.
Shaefi Shahzad,Brenner Samantha K,Gupta Shruti,O'Gara Brian P,Krajewski Megan L,Charytan David M,Chaudhry Sobaata,Mirza Sara H,Peev Vasil,Anderson Mark,Bansal Anip,Hayek Salim S,Srivastava Anand,Mathews Kusum S,Johns Tanya S,Leonberg-Yoo Amanda,Green Adam,Arunthamakun Justin,Wille Keith M,Shaukat Tanveer,Singh Harkarandeep,Admon Andrew J,Semler Matthew W,Hernán Miguel A,Mueller Ariel L,Wang Wei,Leaf David E,
Intensive care medicine
PURPOSE:Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19). METHODS:We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO/FiO < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model. RESULTS:Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41-58), 137 (72.1%) were men, and the median PaO/FiO prior to ECMO initiation was 72 (IQR 61-90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41-0.74). Results were similar in a secondary analysis limited to patients with PaO/FiO < 80 (HR 0.55; 95% CI 0.40-0.77). CONCLUSION:In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.