Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
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Title
Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
Subject
Description
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.
Date
2020-09-25
Type
Citation
Barbaro, Ryan P., Graeme MacLaren, Philip S. Boonstra, Theodore J. Iwashyna, Arthur S. Slutsky, Eddy Fan, Robert H. Bartlett, Joseph E. Tonna, Robert Hyslop, Jeffrey J. Fanning, Peter T. Rycus, Steve J. Hyer, Marc M. Anders, Cara L. Agerstrand, Katarzyna Hryniewicz, Rodrigo Diaz, Roberto Lorusso, Alain Combes, Daniel Brodie, Peta Alexander, Nicholas Barrett, Jan Bělohlávek, Dale Fisher, John Fraser, Ali Ait Hssain, Jae Sung Jung, Michael McMullan, Yatin Mehta, Mark T. Ogino, Matthew L. Paden, Kiran Shekar, Christine Stead, Yasir Abu-Omar, Vanni Agnoletti, Anzila Akbar, Huda Alfoudri, Carlos Alviar, Vladimir Aronsky, Erin August, Georg Auzinger, Hilda Aveja, Rhonda Bakken, Joan Balcells, Sripal Bangalore, Bernard W. Barnes, Alaiza Bautista, Lorraine L. Bellows, Felipe Beltran, Peyman Benharash, Marco Benni, Jennifer Berg, Pietro Bertini, Pablo Blanco-Schweizer, Melissa Brunsvold, Jenny Budd, Debra Camp, Mark Caridi-Scheible, Edmund Carton, Elena Casanova-Ghosh, Anthony Castleberry, Christopher T. Chipongian, Chang Woo Choi, Alessandro Circelli, Elliott Cohen, Michael Collins, Scott Copus, Jill Coy, Brandon Crist, Leonora Cruz, Mirosław Czuczwar, Mani Daneshmand, Daniel Davis Ii, Kim De la Cruz, Cyndie Devers, Toni Duculan, Lucian Durham, Subbarao Elapavaluru, Carlos V. Elzo Kraemer, EdmÍLson Cardoso Filho, Jillian Fitzgerald, Giuseppe Foti, Matthew Fox, David Fritschen, David Fullerton, Elton Gelandt, Stacy Gerle, Marco Giani, Si Guim Goh, Sara Govener, Julie Grone, Miles Guber, Vadim Gudzenko, Daniel Gutteridge, Jennifer Guy, Jonathan Haft, Cameron Hall, Ibrahim Fawzy Hassan, Rubén Herrán, Hitoshi Hirose, Abdulsalam Saif Ibrahim, Don Igielski, Felicia A. Ivascu, Jaume Izquierdo Blasco, Julie Jackson, Harsh Jain, Bhavini Jaiswal, Andrea C. Johnson, Jenniver A. Jurynec, Norma M. Kellter, Adam Kohl, Zachary Kon, Markus Kredel, Karen Kriska, Chandra Kunavarapu, Oude Lansink-Hartgring, Jeliene LaRocque, Sharon Beth Larson, Tracie Layne, Stephane Ledot, Napolitan Lena, Jonathan Lillie, Gösta Lotz, Mark Lucas, Lee Ludwigson, Jacinta J. Maas, Joanna Maertens, David Mast, Scott McCardle, Bernard McDonald, Allison McLarty, Chelsea McMahon, Patrick Meybohm, Bart Meyns, Casey Miller, Fernando Moraes Neto, Kelly Morris, Ralf Muellenbach, Meghan Nicholson, Serena O'Brien, Kathryn O'Keefe, Tawnya Ogston, Gary Oldenburg, Fabiana M. Oliveira, Emily Oppel, Diego Pardo, Diego Pardo, Sara J. Parker, Finn M. Pedersen, Crescens Pellecchia, Jose A. S. Pelligrini, Thao T. N. Pham, Ann R. Phillips, Tasneem Pirani, Paweł Piwowarczyk, Robert Plambeck, William Pruett, Brittany Quandt, Kollengode Ramanathan, Alejandro Rey, Christian Reyher, Jordi Riera del Brio, Rachel Roberts, David Roe, Peter P. Roeleveld, Janet Rudy, Luis F. Rueda, Emanuele Russo, Jesús Sánchez Ballesteros, Nancy Satou, Mauricio Guidi Saueressig, Paul C. Saunders, Margaret Schlotterbeck, Patricia Schwarz, Nicole Scriven, Alexis Serra, Mohammad Shamsah, Lucy Sim, Alexandra Smart, Adam Smith, Deane Smith, Maggie Smith, Neel Sodha, Michael Sonntagbauer, Marc Sorenson, Eric B. Stallkamp, Allison Stewart, Kathy Swartz, Koji Takeda, Shaun Thompson, Bridget Toy, Divina Tuazon, Makoto Uchiyama, Obiora I. Udeozo, Scott van Poppel, Corey Ventetuolo, Leen Vercaemst, Nguyen V. Vinh Chau, I. Wen Wang, Carrie Williamson, Brock Wilson, and Helen Winkels. 2020. "Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry." The Lancet.
Abstract
Summary
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.
Accessibility
Free online on Lancet site.
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