Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic.Methods: Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China.Results: Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, P = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, P = 0.24). As for the ECMO patients, the median age was 58 (47–66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, P = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, P = 0.022), and better CO2 removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, P = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, P = 0.018; 49 vs. 29 days, P = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74).Conclusions: ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.

Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

“…Of 2888 studies identified ( figure ), we selected 123 for full-text review. We included 42 observational cohort studies 13 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 involving 17 449 patients ( table 1 ), predominantly from North America or Europe. We did not identify any randomised controlled trials that met our eligibility criteria.…”

“… 35 , 36 , 37 , 38 , 39 Studies were judged to be at some risk of bias for confounding adjustment and for statistical analysis and reporting if they did not account for clinically important confounders using either logistic regression or Cox proportional hazards models. 15 , 39 , 44 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 Studies reporting adjusted analyses were judged to be at some risk of bias for statistical analysis 35 , 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 , 46 if they did not adhere to methodological standards set by the PROGRESS guidelines, 19 , 20 , 21 , 22 in particular with regards to a priori selection of clinically important confounders and consideration of an appropriate sample size to minimise potential overfitting. 28 , 76 The composition and methodological quality of individual prediction models for each study and funnel plots used to evaluate for publication bias among variables that were assessed in at least ten studies are included in the appendix (p 36–41 ).…”

“…In the second analysis, we excluded adjusted analyses from studies with a potential risk of bias due to poor adherence to best practice methodological guidelines for prediction model development. 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 We considered the use of metaregression to further explore subgroups of interest, but did not have a sample size of ten or more studies per adjusted variable, as recommended by Cochrane guidance. 47 For the unadjusted analyses, we decided not to use study-level metaregression because it was unlikely to further benefit the analysis.…”

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

“…1 , Additional file 1 : Table S4) [ 3 , 5 , 16 – 65 ]. All studies were retrospective and observational in nature; 22 studies were conducted by studies centres from Europe [ 5 , 17 , 19 , 23 , 27 , 29 , 31 – 34 , 36 , 39 , 42 , 43 , 45 , 46 , 50 , 55 , 56 , 60 , 63 , 65 ], 17 from North America [ 16 , 18 , 20 – 22 , 24 , 25 , 37 , 40 , 47 , 48 , 52 – 54 , 57 , 58 , 61 ], 6 from the Asia–Pacific [ 26 , 28 , 35 , 38 , 41 , 44 ], 2 from South-West Asia and Africa,[ 51 , 62 ] 2 from Latin America [ 30 , 64 ], and 3 were studies conducted by centres from multiple ELSO regions [ 3 , 49 , 59 ], of which 2 were based on registry data [ 3 , 49 ]. The pooled age was 52.5 years (95% CI 50.7 to 54.3), and the majority of patients were male (75.0%, 95% CI 72.4% to 77.4%) and obese (BMI: 31.0, 95% CI 30.2 to 31.8).…”

Promoting self‐healing power and balancing immune response: a holistic, effective strategy of traditional Chinese medicine in treating COVID‐19

“…In the early stage of the pandemic in Wuhan, some hospitals used the supportive care combined with antivirals and glucocorticoids, resulting in high mortality and low cure rate [19] , [20] , [21] , [22] , [23] . After TCM participation, the mortality rate was significantly reduced.…”