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Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study

BACKGROUND: In patients with severe respiratory failure from COVID-19, extracorporeal membrane oxygenation (ECMO) treatment can facilitate lung-protective ventilation and may improve outcome and survival if conventional therapy fails to assure adequate oxygenation and ventilation. We aimed to perfor...

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Autores principales: Stessel, Björn, Bin Saad, Maayeen, Ullrick, Lotte, Geebelen, Laurien, Lehaen, Jeroen, Timmermans, Philippe Jr, Van Tornout, Michiel, Callebaut, Ina, Vandenbrande, Jeroen, Dubois, Jasperina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10279486/
https://www.ncbi.nlm.nih.gov/pubmed/37342313
http://dx.doi.org/10.1155/2023/5101456
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author Stessel, Björn
Bin Saad, Maayeen
Ullrick, Lotte
Geebelen, Laurien
Lehaen, Jeroen
Timmermans, Philippe Jr
Van Tornout, Michiel
Callebaut, Ina
Vandenbrande, Jeroen
Dubois, Jasperina
author_facet Stessel, Björn
Bin Saad, Maayeen
Ullrick, Lotte
Geebelen, Laurien
Lehaen, Jeroen
Timmermans, Philippe Jr
Van Tornout, Michiel
Callebaut, Ina
Vandenbrande, Jeroen
Dubois, Jasperina
author_sort Stessel, Björn
collection PubMed
description BACKGROUND: In patients with severe respiratory failure from COVID-19, extracorporeal membrane oxygenation (ECMO) treatment can facilitate lung-protective ventilation and may improve outcome and survival if conventional therapy fails to assure adequate oxygenation and ventilation. We aimed to perform a confirmatory propensity-matched cohort study comparing the impact of ECMO and maximum invasive mechanical ventilation alone (MVA) on mortality and complications in severe COVID-19 pneumonia. MATERIALS AND METHODS: All 295 consecutive adult patients with confirmed COVID-19 pneumonia admitted to the intensive care unit (ICU) from March 13(th), 2020, to July 31(st), 2021 were included. At admission, all patients were classified into 3 categories: (1) full code including the initiation of ECMO therapy (AAA code), (2) full code excluding ECMO (AA code), and (3) do-not-intubate (A code). For the 271 non-ECMO patients, match eligibility was determined for all patients with the AAA code treated with MVA. Propensity score matching was performed using a logistic regression model including the following variables: gender, P/F ratio, SOFA score at admission, and date of ICU admission. The primary endpoint was ICU mortality. RESULTS: A total of 24 ECMO patients were propensity matched to an equal number of MVA patients. ICU mortality was significantly higher in the ECMO arm (45.8%) compared with the MVA cohort (16.67%) (OR 4.23 (1.11, 16.17); p=0.02). Three-month mortality was 50% with ECMO compared to 16.67% after MVA (OR 5.91 (1.55, 22.58); p < 0.01). Applied peak inspiratory pressures (33.42 ± 8.52 vs. 24.74 ± 4.86 mmHg; p < 0.01) and maximal PEEP levels (14.47 ± 3.22 vs. 13.52 ± 3.86 mmHg; p=0.01) were higher with MVA. ICU length of stay (LOS) and hospital LOS were comparable in both groups. CONCLUSION: ECMO therapy may be associated with an up to a three-fold increase in ICU mortality and 3-month mortality compared to MVA despite the facilitation of lung-protective ventilation settings in mechanically ventilated COVID-19 patients. We cannot confirm the positive results of the first propensity-matched cohort study on this topic. This trial is registered with NCT05158816.
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spelling pubmed-102794862023-06-20 Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study Stessel, Björn Bin Saad, Maayeen Ullrick, Lotte Geebelen, Laurien Lehaen, Jeroen Timmermans, Philippe Jr Van Tornout, Michiel Callebaut, Ina Vandenbrande, Jeroen Dubois, Jasperina Crit Care Res Pract Research Article BACKGROUND: In patients with severe respiratory failure from COVID-19, extracorporeal membrane oxygenation (ECMO) treatment can facilitate lung-protective ventilation and may improve outcome and survival if conventional therapy fails to assure adequate oxygenation and ventilation. We aimed to perform a confirmatory propensity-matched cohort study comparing the impact of ECMO and maximum invasive mechanical ventilation alone (MVA) on mortality and complications in severe COVID-19 pneumonia. MATERIALS AND METHODS: All 295 consecutive adult patients with confirmed COVID-19 pneumonia admitted to the intensive care unit (ICU) from March 13(th), 2020, to July 31(st), 2021 were included. At admission, all patients were classified into 3 categories: (1) full code including the initiation of ECMO therapy (AAA code), (2) full code excluding ECMO (AA code), and (3) do-not-intubate (A code). For the 271 non-ECMO patients, match eligibility was determined for all patients with the AAA code treated with MVA. Propensity score matching was performed using a logistic regression model including the following variables: gender, P/F ratio, SOFA score at admission, and date of ICU admission. The primary endpoint was ICU mortality. RESULTS: A total of 24 ECMO patients were propensity matched to an equal number of MVA patients. ICU mortality was significantly higher in the ECMO arm (45.8%) compared with the MVA cohort (16.67%) (OR 4.23 (1.11, 16.17); p=0.02). Three-month mortality was 50% with ECMO compared to 16.67% after MVA (OR 5.91 (1.55, 22.58); p < 0.01). Applied peak inspiratory pressures (33.42 ± 8.52 vs. 24.74 ± 4.86 mmHg; p < 0.01) and maximal PEEP levels (14.47 ± 3.22 vs. 13.52 ± 3.86 mmHg; p=0.01) were higher with MVA. ICU length of stay (LOS) and hospital LOS were comparable in both groups. CONCLUSION: ECMO therapy may be associated with an up to a three-fold increase in ICU mortality and 3-month mortality compared to MVA despite the facilitation of lung-protective ventilation settings in mechanically ventilated COVID-19 patients. We cannot confirm the positive results of the first propensity-matched cohort study on this topic. This trial is registered with NCT05158816. Hindawi 2023-06-12 /pmc/articles/PMC10279486/ /pubmed/37342313 http://dx.doi.org/10.1155/2023/5101456 Text en Copyright © 2023 Björn Stessel et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Stessel, Björn
Bin Saad, Maayeen
Ullrick, Lotte
Geebelen, Laurien
Lehaen, Jeroen
Timmermans, Philippe Jr
Van Tornout, Michiel
Callebaut, Ina
Vandenbrande, Jeroen
Dubois, Jasperina
Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study
title Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study
title_full Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study
title_fullStr Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study
title_full_unstemmed Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study
title_short Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A Propensity-Matched Cohort Study
title_sort extracorporeal membrane oxygenation to support covid-19 patients: a propensity-matched cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10279486/
https://www.ncbi.nlm.nih.gov/pubmed/37342313
http://dx.doi.org/10.1155/2023/5101456
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