Risk factors for mortality in patients with COVID-19 needing extracorporeal respiratory support

Riera, Jordi; Alcántara, Sara; Bonilla, Camilo; Fortuna, Phillip; Ortíz, Aaron Blandino; Vaz, Ana Paula; Albacete, Carlos; Millán, Pablo; Ricart, Pilar; Boado, María Victoria; Gopegui, Pablo Ruiz de; Teresa, Patricia; Sandoval, Elena; Pérez-Chomón, Helena; González‐Pérez, Alfredo; Duerto, Jorge; Gimeno, Ricardo; Colomina, Joaquín; Gómez, Vanesa; Renedo, Gloria; Naranjo, José Ricardo; Sanchez-Garcia, Manuel A.; Rodríguez-Ruiz, Emilio; Silva, Pedro Eduardo; Pérez, Daniel; Veganzones, Javier; Voces, Roberto; Martínez, Santiago; Blanco-Schweizer, Pablo; García, Marta; Villanueva-Fernández, Héctor; Fuset, María Paz; Luna, Stephani María; Martínez-Martínez, María; Argudo, Eduard; Chiscano, Luis; Roncon‐Albuquerque, Roberto

doi:10.1183/13993003.02463-2021

Cited by 28 publications

(29 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Application of these criteria appeared consistent over time in our study, with clinical characteristics of ECMO patients remaining similar across waves (barring pre-ECMO therapeutic interventions). Second, all patients were retrieved on ECMO and treated in high-volume ECMO centres, which may associate with improved survival [26,32]. These differences may highlight the impact of selective inclusion criteria, and centralised ECMO provisioning structures.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study

et al. 2022

View full text Add to dashboard Cite

Purpose: Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 . The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality. Methods:A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques.Results: 1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29-0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre. Conclusion:We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered.

show abstract

Section: Discussionmentioning

confidence: 99%

Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

Background Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes. Methods We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology. Results Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8–52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run. Conclusions The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation.

show abstract

“…The ECMOVIBER (ECMO during the COVID-19 pandemic in the Iberian peninsula) study confirmed the overall decrease in the survival of ECMO patients over the pandemic. [ 41 ] In the retrospective, observational study, which included 319 patients from 24 centers, the authors reported a significant increase in mortality during the second wave (60.1% vs . 41.1%, P =0.001).…”

Section: Ecmo and Ssubsequent Waves Of Covid-19mentioning

confidence: 99%

Extracorporeal membrane oxygenation in COVID-19 associated acute respiratory distress syndrome: A narrative review

Assouline

Schmidt

2023

Journal of Intensive Medicine

View full text Add to dashboard Cite

Risk factors for mortality in patients with COVID-19 needing extracorporeal respiratory support

Cited by 28 publications

References 15 publications

Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study

Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study

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

Extracorporeal membrane oxygenation in COVID-19 associated acute respiratory distress syndrome: A narrative review

Contact Info

Product

Resources

About