@article{f06c2e59fddb4d86a8d309d69ddadde5,
title = "Venovenous extracorporeal membrane oxygenation in patients with acute covid-19 associated respiratory failure: comparative effectiveness study",
abstract = "Objective To estimate the effect of extracorporeal membrane oxygenation (ECMO) compared with conventional mechanical ventilation on outcomes of patients with covid-19 associated respiratory failure. Design Observational study. Setting 30 countries across five continents, 3 January 2020 to 29 August 2021. Participants 7345 adults admitted to the intensive care unit with clinically suspected or laboratory confirmed SARS-CoV-2 infection. Interventions ECMO in patients with a partial pressure of arterial oxygen to fraction of inspired oxygen (PaO 2 /FiO 2) ratio <80 mm Hg compared with conventional mechanical ventilation without ECMO. Main outcome measure The primary outcome was hospital mortality within 60 days of admission to the intensive care unit. Adherence adjusted estimates were calculated using marginal structural models with inverse probability weighting, accounting for competing events and for baseline and time varying confounding. Results 844 of 7345 eligible patients (11.5\%) received ECMO at any time point during follow-up. Adherence adjusted mortality was 26.0\% (95\% confidence interval 24.5\% to 27.5\%) for a treatment strategy that included ECMO if the PaO 2 /FiO 2 ratio decreased <80 mm Hg compared with 33.2\% (31.8\% to 34.6\%) had patients received conventional treatment without ECMO (risk difference -7.1\%, 95\% confidence interval -8.2\% to -6.1\%; risk ratio 0.78, 95\% confidence interval 0.75 to 0.82). In secondary analyses, ECMO was most effective in patients aged <65 years and with a PaO 2 /FiO 2 <80 mm Hg or with driving pressures >15 cmH 2 O during the first 10 days of mechanical ventilation. Conclusions ECMO was associated with a reduction in mortality in selected adults with covid-19 associated respiratory failure. Age, severity of hypoxaemia, and duration and intensity of mechanical ventilation were found to be modifiers of treatment effectiveness and should be considered when deciding to initiate ECMO in patients with covid-19. ",
author = "Martin Urner and Barnett, \{Adrian G.\} and Bassi, \{Gianluigi Li\} and Daniel Brodie and Dalton, \{Heidi J.\} and Ferguson, \{Niall D.\} and Silver Heinsar and Hodgson, \{Carol L.\} and Giles Peek and Kiran Shekar and Suen, \{Jacky Y.\} and Fraser, \{John F.\} and Eddy Fan",
note = "Funding Information: Funding: The COVID-19 Critical Care Consortium received funding from the University of Queensland, Wesley Medical Research, the Prince Charles Hospital Foundation, Queensland Department of Health, the Health Research Board of Ireland, Biomedicine international training research programme for excellent clinician-scientists, European Union{\textquoteright}s research and innovation programme (Horizon 2020), the Extracorporeal Life Support Organization, the International ECMO Network, la Caixa Foundation, and Fisher and Paykel Healthcare. The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/coi\_dischlosure. pdf. MU is supported by a Vanier Canada graduate scholarship from the Canadian Institutes of Health Research. AGB is supported by a National Health and Medical Research Council fellowship. SH is supported by a PhD scholarship from the Prince Charles Hospital Foundation. EF reports personal fees from ALung Technologies, Aerogen, Baxter, Boehringer-Ingelheim, GE Healthcare, Inspira, and Vasomune outside the submitted work; he is the chair of the research committee, Extracorporeal Life Support Organization (ELSO) and chair of the data committee, International ECMO Network (ECMONet). DB receives research support from ALung Technologies. He reports personal fees from Abiomed, Medtronic, Inspira, Cellenkos, and Xenios; he is the president-elect of ELSO and chair of the executive committee of ECMONet. GLB is a recipient of the Biomedicine international training research programme for excellent clinician-scientists (BITRECS) fellowship; the BITRECS project has received funding from the European Union{\textquoteright}s Horizon 2020 research and innovation programme under the Marie Sk{\l}odowska-Curie (grant agreement No 754550) and from the La Caixa Foundation (ID 100010434), under agreement LCF/PR/GN18/50310006. JFF reports grant support from FP, Xenios, Getinge, Cynata, CSL, and Queensland Health outside the submitted work. CLH is supported by a National Health and Medical Research Council investigator grant from Australia. KS acknowledges research support from Metro North Hospital and Health Service. JYS is supported by the Advance Queensland Fellowship from the Queensland government. Funding Information: 16Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada 17Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia 18Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia 19Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia 20Congenital Heart Center, University of Florida, Gainesville, FL, USA This study is supported by the COVID-19 Critical Care Consortium. We thank the clinicians, patients, and families who contribute data to this study. We recognise the importance of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) and Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) networks for the development and expansion of the COVID-19 Critical Care Consortium. We thank the generous support we received from the Extracorporeal Life Support Organization and the International ECMO Network. Finally, we acknowledge all members of the COVID-19 Critical Care Consortium and various collaborators. The supplementary appendix includes a list of members and collaborators. Publisher Copyright: {\textcopyright} ",
year = "2022",
month = may,
day = "4",
doi = "10.1136/bmj-2021-068723",
language = "English",
volume = "377",
journal = "BMJ",
issn = "0959-535X",
publisher = "BMJ",
}