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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
The Lancet, Volume 396, No. 10257, Year 2020
Notification
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Description
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. © 2020 Elsevier Ltd
Authors & Co-Authors
Barbaro, Ryan P.
United States, Ann Arbor
University of Michigan, Ann Arbor
MacLaren, Graeme
Singapore, Singapore City
National University Health System
Boonstra, Philip S.
United States, Ann Arbor
University of Michigan, Ann Arbor
Iwashyna, Theodore J.
United States, Ann Arbor
University of Michigan Medical School
United States
Va Medical Center
Slutsky, Arthur S.
Canada, Toronto
University of Toronto
Canada, Toronto
Li ka Shing Knowledge Institute
Fan, Eddy
Canada, Toronto
University of Toronto
Bartlett, Robert H.
United States, Ann Arbor
University of Michigan, Ann Arbor
Agerstrand, Cara L.
United States, New York
New York Presbyterian Hospital
Hryniewicz, Katarzyna M.
United States, Minneapolis
Abbott Northwestern Hospital
Díaz, Rodrigo A.
Chile, Santiago
Clínica Las Condes
Lorusso, Roberto R.
Netherlands, Maastricht
Universiteit Maastricht
Combes, Alain
France, Paris
Inserm
France, Paris
Hôpital Universitaire Pitié Salpêtrière
Brodie, Daniel M.
United States, New York
New York Presbyterian Hospital
Alexander, Peta M.A.
Unknown Affiliation
Barrett, Nicholas A.
Unknown Affiliation
Bělohlávek, Jan
Unknown Affiliation
Fisher, Dale Andrew
Unknown Affiliation
Fraser, John F.
Unknown Affiliation
Ait Hssain, Ali
Unknown Affiliation
Mehta, Yatin B.
Unknown Affiliation
Ogino, Mark T.
Unknown Affiliation
Paden, Matthew L.
Unknown Affiliation
Shekar, Kiran V.
Unknown Affiliation
Stead, Christine M.
Unknown Affiliation
Abu-Omar, Yasir
Unknown Affiliation
Vanni, Agnoletti
Unknown Affiliation
Alfoudri, Huda
Unknown Affiliation
Balcells, Joan
Unknown Affiliation
Bangalore, Sripal
Unknown Affiliation
Bertini, Pietro
Unknown Affiliation
Czuczwar, Miroslaw
Unknown Affiliation
Elapavaluru, Subbarao
Unknown Affiliation
Foti, Giuseppe
Unknown Affiliation
Giani, Marco
Unknown Affiliation
Hassan, Ibrahim Fawzy
Unknown Affiliation
Ibrahim, Abdulsalam Saif S.
Unknown Affiliation
Lucas, Mark T.
Unknown Affiliation
Meybohm, Patrick
Unknown Affiliation
Meyns, Bart P.
Unknown Affiliation
Ramanathan, Kollengode R.
Unknown Affiliation
Reyher, Christian
Unknown Affiliation
Roberts, Rachel
Unknown Affiliation
Serra, Alexis L.
Unknown Affiliation
Shamsah, Mohammad A.
Unknown Affiliation
Takeda, Koji
Unknown Affiliation
Ventetuolo, Corey E.
Unknown Affiliation
Williamson, Carolyn
Unknown Affiliation
Statistics
Citations: 587
Authors: 47
Affiliations: 15
Identifiers
Doi:
10.1016/S0140-6736(20)32008-0
ISSN:
01406736
Research Areas
Covid
Disability
Environmental
Health System And Policy
Study Design
Cohort Study
Study Approach
Quantitative