ECMO for severe ARDS associated with COVID-19: now we know we can, but should we?

Shekar, Kiran; Slutsky, Arthur S.; Brodie, Daniel

doi:10.1016/s2213-2600(20)30357-x

Cited by 25 publications

(27 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a cohort study of 83 ECMO-treated COVID-19 patients from five ICUs of one university hospital network, Schmidt et al estimated that 31% of patients deceased at 60 days ( 19 ). The mortality of a longer term was unknown, because 24% of patients were still in ICUs in the study of Schmidt et al ( 19 ) and Shekar et al ( 20 ). Based on ELSO Registry of ECMO in COVID-19 with 779 ECMO-treated patients with ARDS, Barbaro et al found that their median age was 50 years and estimated that their in-hospital mortality at 90-day was 38.0% (95% confidence interval 34.6–41.5%) ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

Yang

et al. 2021

Front. Med.

View full text Add to dashboard Cite

Background: The data on long-term outcomes of patients infected by SARS-CoV-2 and treated with extracorporeal membrane oxygenation (ECMO) in China are merely available.Methods: A retrospective study included 73 patients infected by SARS-CoV-2 and treated with ECMO in 21 intensive care units in Hubei, China. Data on demographic information, clinical features, laboratory tests, ECMO durations, complications, and living status were collected.Results: The 73 ECMO-treated patients had a median age of 62 (range 33–78) years and 42 (63.6%) were males. Before ECMO initiation, patients had severe respiratory failure on mechanical ventilation with a median PO2/FiO2 of 71.9 [interquartile range (IQR), 58.6–87.0] mmHg and a median PCO2 of 62 [IQR, 43–84] mmHg on arterial blood analyses. The median duration from symptom onset to invasive mechanical ventilation, and to ECMO initiation was19 [IQR, 15–25] days, and 23 [IQR, 19–31] days. Before and after ECMO initiation, the proportions of patients receiving prone position ventilation were 58.9 and 69.9%, respectively. The median duration of ECMO support was 18.5 [IQR 12–30] days. During the treatments with ECMO, major hemorrhages occurred in 31 (42.5%) patients, and oxygenators were replaced in 21 (28.8%) patients. Since ECMO initiation, the 30-day mortality and 60-day mortality were 63.0 and 80.8%, respectively.Conclusions: In Hubei, China, the ECMO-treated patients infected by SARS-CoV-2 were of a broad age range and with severe hypoxemia. The durations of ECMO support, accompanied with increased complications, were relatively long. The long-term mortality in these patients was considerably high.

show abstract

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

Yang

et al. 2021

Front. Med.

View full text Add to dashboard Cite

show abstract

“…In this large national cohort analysis of COVID-19 patients with ARDS who underwent ECMO therapy, the overall in-hospital mortality was 45.9% which is substantially lower than initial early reports. 6 , 7 Among patients with COVID-19 who underwent ECMO therapy, there was an increase in mortality with increasing age with the highest mortality among patients over 65 years old. In a subset analysis of COVID-19 patients with ARDS who were between 18–64 years, we found a high mortality rate for patients managed with and without ECMO therapy (44.6% vs. 37.9%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Early reports of ECMO in management of COVID-19 patients demonstrated exceedingly high mortality. 6 , 7 In a pooled analysis of early reports, Henry et al reported on 234 COVID-19 patients with ARDS; 17 underwent ECMO with a mortality rate of 94.1%. 6 The largest series to date was reported from the extracorporeal life support organization (ELSO) registry on 1,032 patients who underwent ECMO for management of ARDS related to COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…Preliminary small case series showed poor survival with mortality in excess of 90%. 6 , 7 The National Institute of Health (NIH) COVID-19 treatment guidelines state that there are insufficient data to recommend either for or against the routine use of ECMO for patients with COVID-19 and refractory hypoxemia. 8 There has been only a single large-scale, multicenter study to date reporting on 1032 COVID-19 patients who underwent ECMO in 36 countries.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Analysis of COVID-19 Patients With Acute Respiratory Distress Syndrome Managed With Extracorporeal Membrane Oxygenation at US Academic Centers

et al. 2021

View full text Add to dashboard Cite

Objective: This study analyzed the outcomes of COVID-19 patients with ARDS who were managed with extracorporeal membrane oxygenation (ECMO) across 155 US academic centers. Summary Background Data: ECMO has been utilized in COVID-19 patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia. Early case series with the use of ECMO in these patients reported high mortality exceeding 90%. Methods: Using ICD-10 codes, data of patients with COVID-19 with ARDS, managed with ECMO between April and September 2020, were analyzed using the Vizient clinical database. Outcomes measured included in-hospital mortality, hospital and ICU length of stay, and direct cost. For comparative purposes, the outcome of a subset of COVID-19 patients aged between 18 and 64 years and managed with versus without ECMO were examined. Results: 1,182 patients with COVID-19 and ARDS received ECMO. In-hospital mortality was 45.9%, mean length of stay was 36.8 ± 24.9 days, and mean ICU stay was 29.1 ± 17.3 days. In-hospital mortality according to age group was 25.2% for 1 to 30 years; 42.2% for 31 to 50 years; 53.2% for 51 to 64 years; and 73.7% for ≥65 years. A subset analysis of COVID-19 patients, aged 18 to 64 years with ARDS requiring mechanical ventilation and managed with (n = 1113) vs without (n = 16,343) ECMO, showed relatively high in-hospital mortality for both groups (44.6% with ECMO vs 37.9% without ECMO). Conclusions: In this large US study of patients with COVID-19 and ARDS managed with ECMO, the in-hospital mortality is high but much lower than initial reports. Future research is needed to evaluate which patients with COVID-19 and ARDS would benefit from ECMO.

show abstract

“…The median duration from symptom onset to invasive mechanical ventilation, and to ECMO initiation was 19 [IQR, [15][16][17][18][19][20][21][22][23][24][25] days, and 23 [IQR, [19][20][21][22][23][24][25][26][27][28][29][30][31] days, with details listed in Table 3 separately based on the outcomes of the patients. Only 1 (1.4%) patient had ECMO initiated while receiving non-invasive mechanical ventilation.…”

Section: Resultsmentioning

confidence: 99%

Table_1.pdf

View full text Add to dashboard Cite

ECMO for severe ARDS associated with COVID-19: now we know we can, but should we?

Cited by 25 publications

References 9 publications

Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

Analysis of COVID-19 Patients With Acute Respiratory Distress Syndrome Managed With Extracorporeal Membrane Oxygenation at US Academic Centers

Table_1.pdf

Contact Info

Product

Resources

About