TY  - JOUR
AU  - Barbaro, RP
AU  - MacLaren, G
AU  - Boonstra, PS
AU  - Iwashyna, TJ
AU  - Slutsky, AS
AU  - Fan, E
AU  - Bartlett, RH
AU  - Tonna, JE
AU  - Hyslop, R
AU  - Fanning, JJ
AU  - Rycus, PT
AU  - Hyer, SJ
AU  - Anders, MM
AU  - Agerstrand, CL
AU  - Hryniewicz, K
AU  - Diaz, R
AU  - Lorusso, R
AU  - Combes, A
AU  - Brodie, D
Y2  - 2020/12/16
Y1  - 2020/10/10
SN  - 0140-6736
UR  - http://hdl.handle.net/11343/254577
AB  - 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.
LA  - English
PB  - ELSEVIER SCIENCE INC
T1  - Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
DO  - 10.1016/S0140-6736(20)32008-0
IS  - The Lancet
VL  - 396
IS  - 10257
SP  - 1071-1078
ER  -