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Hajage, David; Combes, Alain; Guervilly, Christophe; Lebreton, Guillaume; Mercat, Alain; Pavot, Arthur; Nseir, Saad; Mekontso-Dessap, Armand; Mongardon, Nicolas; Mira, Jean Paul; Ricard, Jean-Damien; Beurton, Alexandra; Tachon, Guillaume; Kontar, Loay; Le Terrier, Christophe; Richard, Jean Christophe; Mégarbane, Bruno; Keogh, Ruth H; Belot, Aurélien; Maringe, Camille; Leyrat, Clémence; Schmidt, Matthieu
American journal of respiratory and critical care medicine, 08/2022, Letnik: 206, Številka: 3Journal Article, Web Resource
Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. To estimate the effect of ECMO on 90-day mortality versus IMV only. Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO versus no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (Pa /Fi < 80 or Pa ⩾ 60 mm Hg). We controlled for confounding using a multivariable Cox model on the basis of predefined variables. A total of 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability on Day 7 from the onset of eligibility criteria (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0-9%), which decreased during follow-up (survival on Day 90: 63% vs. 65%; risk difference, -2%; 95% confidence interval, -10 to 5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand and when initiated within the first 4 days of IMV and in patients who are profoundly hypoxemic. In an emulated trial on the basis of a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and regions with ECMO capacities specifically organized to handle high demand.
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Leto | Faktor vpliva | Izdaja | Kategorija | Razvrstitev | ||||
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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Povezave do osebnih bibliografij avtorjev | Povezave do podatkov o raziskovalcih v sistemu SICRIS |
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Vir: Osebne bibliografije
in: SICRIS
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