Venovenous extracorporeal membrane oxygenation in patients with acute covid-19 associated respiratory failure: comparative effectiveness study

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 Augu...

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Detalles Bibliográficos
Autores principales: Urner, Martin, Barnett, Adrian G, Bassi, Gianluigi Li, Brodie, Daniel, Dalton, Heidi J, Ferguson, Niall D, Heinsar, Silver, Hodgson, Carol L, Peek, Giles, Shekar, Kiran, Suen, Jacky Y, Fraser, John F, Fan, Eddy, Al-Dabbous, Tala, Alfoudri, Huda, Elapavaluru, Subbarao, Berg, Ashley, Horn, Christina, Schroll, Stephan, Velazco, Jorge, Fikes, Wanda, Ploskanych, Ludmyla, Meyer, Dan, Shalabi-McGuire, Maysoon, Witt, Trent, Ehlers, Ashley, Grazioli, Lorenzo, Grandin, E Wilson, Nunez, Jose, Reyes, Tiago, Joseph, Mark, Mitchell, Brook, Tenzer, Martha, Abe, Ryuzo, Hayashi, Yosuke, Cho, Hwa Jin, Jeong, In Seok, Brozzi, Nicolas, Hernandez-Montfort, Jaime, Mehkri, Omar, Houltham, Stuart, Graf, Jerónimo, Perez, Rodrigo, Diaz, Roderigo, Delgado, Camila, González, Joyce, Sanchez, Maria Soledad, Rincón, Diego Fernando Bautista, Duque, Melissa Bustamante, Marulanda Yanten, Angela Maria, Rusmawatiningtyas, Desy, Ragazzo, Gabrielle, Taufik, Azhari, Gunawan, Margaretha, Irawany, Vera, Rayhan, Muhammad, Wardoyo, Elizabeth Yasmin, Panigada, Mauro, Coppola, Silvia, Colombo, Sebastiano, Grasselli, Giacomo, Leone, Michela, Zanella, Alberto, Antonelli, Massimo, Carelli, Simone, Grieco, Domenico, Asaki, Motohiro, Hoshino, Kota, Salazar, Leonardo, Duarte, Laura, McCaffrey, Joseph, Bone, Allison, Thomson, David, Arnold-Day, Christel, Cupido, Jerome, Fanie, Zainap, Miller, Malcom, Seymore, Lisa, van Straaten, Dawid, Hassan, Ibrahim, Hssain, Ali Ait, Aliudin, Jeffrey, Alqahtani, Al-Reem, Mohamed, Khoulod, Mohamed, Ahmed, Tan, Darwin, Villanueva, Joy, Zaqout, Ahmed, Kurtzman, Ethan, Ademi, Arben, Dobrita, Ana, El Aoudi, Khadija, Segura, Juliet, Giwangkancana, Gezy, Ohshimo, Shinichiro, Hoshino, Koji, Hitoshi, Saito, Uchinami, Yuka, Osatnik, Javier, Joosten, Anne, Torres, Antoni, Motos, Ana, Yang, Minlan, Luna, Carlos, Arancibia, Francisco, Williams, Virginie, Noel, Alexandre, Luque, Nestor, Trung, Trieu Huynh, Yacoub, Sophie, Fantini, Marina, Jorge García, Ruth Noemi, Alvarez, Enrique Chicote, Greti, Anna, Lomeli, Oscar, Ceccato, Adrian, Sanchez, Angel, Vazquez, Ana Loza, Roche-Campo, Ferran, Tuazon, Divina, Duculan, Toni, Shimizu, Hiroaki, Amato, Marcelo, Cassimiro, Luciana, Pola, Flavio, Ribeiro, Francis, Fonseca, Guilherme, Desai, Mehul, Osborn, Erik, Deeb, Hala, Arcadipane, Antonio, Bianco, Claudia, Cuffaro, Raffaele, Martucci, Gennaro, Occhipinti, Giovanna, Rossetti, Matteo, Vitiello, Chiara, Cho, Sung-Min, Calligy, Kate, Whitman, Glenn, Moriyama, Naoki, Kim, Jae-Burm, Kitamura, Nobuya, Shimazui, Takashi, Al-Hudaib, Abdullah, Elhazmi, Alyaa, Gebauer, Johannes, Yokoyama, Toshiki, Al-Fares, Abdulrahman, Alamad, Esam, Alawadhi, Fatma, Alawadi, Kalthoum, Buabbas, Sarah, Tanaka, Hiro, Hashimoto, Satoru, Yamazaki, Masaki, Oh, Tak-Hyuck, Epler, Mark, Forney, Cathleen, Feister, Jared, Grobengieser, Katherine, Kruse, Louise, Williamson, Joelle, Gnall, Eric, Caroline, Mara, Golden, Sasha, Karaj, Colleen, McDermott, Sherry, Sher, Lynn, Shapiro, Timothy, Thome, Lisa, Vanderland, Mark, Welch, Mary, Brazzi, Luca, Ogston, Tawnya, Nagpal, Dave, Fischer, Karlee, Lorusso, Roberto, de Piero, Maria, Esperatti, Mariano, O’Briain, Diarmuid, Carton, Edmund G, Sen, Ayan, Palacios, Amanda, Rainey, Deborah, Seefeldt, Cassandra, Durham, Lucia, Falcucci, Octavio, Emmrich, Amanda, Guy, Jennifer, Johns, Carling, Neumann, Emily, Buchtele, Nina, Schwameis, Michael, Stecher, Stephanie-Susanne, Singh, Delila, Barnikel, Michaela, Arenz, Lukas, Zaaqoq, Akram, Galloway, Lan Anh, Merley, Caitlin, Csete, Marc, Quesada, Luisa, Saba, Isabela, Kasugai, Daisuke, Hiraiwa, Hiroaki, Tanaka, Taku, Marwali, Eva, Chen, Yih-Sharng, Laffey, John, VanDyk, Marlice, MacDonald, Sarah, Seppelt, Ian, Ratsep, Indrek, Enneveer, Lauri, Erikson, Kristo, Oigus, Getter, Post, Andra-Maris, Sillaots, Piret, Mihelis, Effe, Komats, Mamoru, Satyapriya, S Veena, Bhatt, Amar, Echeverria, Marco, Fiorda, Juan, Gonzalez, Alicia, Mokadam, Nahush A, McKeown, Johnny, Pasek, Joshua, Shi, Haixia, Uribe, Alberto, Moreno, Rita, Zakhary, Bishoy, Johnson, Hannah, Pow, Nolan, Cavana, Marco, Cucino, Alberto, Foti, Giuseppe, Giani, Marco, Russotto, Vincenzo, Chiumello, Davide, Castagna, Valentina, Dell’Amore, Andrea, Shum, Hoi-Ping, Vuysteke, Alain, Usman, Asad, Acker, Andrew, Mergler, Blake, Rizer, Nicolas, Sertic, Federico, Smood, Benjamin, Sperry, Alexandra, Subramanian, Madhu, Lolong, Navy, Akmal, Ernita, Burhan, Erlina, Rasmin, Menaldi, Naivedh, Bhat, Barrett, Peter, Daugherty, Julia, Dean, David, Loforte, Antonio, Khan, Irfan, DeSantis, Olivia, Quraishi, Mohammed Abraar, Salt, Gavin, So, Dominic, Kandamby, Darshana, Mandei, Jose M, Natanael, Hans, Lantang, Eka Yudha, Lantang, Anastasia, Jung, Anna, Hammond, Terese, Ng, George, Ng, Wing Yiu, Yeung, Pauline, Adachi, Shingo, Blanco, Pablo, Prieto, Ana, Sánchez, Jesús, Nicholson, Meghan, Farquharson, Michael, Butt, Warwick, Serratore, Alyssa, Delzoppo, Carmel, Janin, Pierre, Yarad, Elizabeth, Totaro, Richard, Coles, Jennifer, Balk, Robert, Fox, Samuel, Hays, James, Kapania, Esha, Mishin, Pavel, Vissing, Andy, Yantosh, Garrett, Yuliarito, Saptadi, Santoso, Kohar Hari, Djajalaksana, Susanthy, Fatoni, Arie Zainul, Fukuda, Masahiro, Liu, Keibun, Pelosi, Paolo, Battaglini, Denise, Jiménez, Juan Fernando Masa, Gaião, Sérgio, Roncon-Albuquerque, Roberto, Buchner, Jessica, Cho, Young-Jae, Lee, Sang Min, Lee, Su Hwan, Kawasaki, Tatsuya, Sakiyalak, Pranya, Nitayavardhana, Prompak, Seitz, Tamara, Arora, Rakesh, Kent, David, Parwar, Swapnil, Cheng, Andrew, Miller, Jennene, Marino, Daniel, Deacon, Jillian E, Fujitani, Shigeki, Shimizu, Naoki, Madhok, Jai, Owyang, Clark, Buscher, Hergen, Reynolds, Claire, Maasikas, Olavi, Beljantsev, Aleksandr, Mihnovits, Vladislav, Akimoto, Takako, Aizawa, Mariko, Horibe, Kanako, Onodera, Ryota, Young, Meredith, Smith, Timothy, Bartone, Cheryl, George, Timothy, McGuinness, Niki, Irvine, Lacey, Flynn, Brigid, Houchin, Abigail, Shimizu, Keiki, Hamaguchi, Jun, Lussier, Leslie, Kersker, Grace, Reich, John Adam, Lotz, Gösta, Malfertheiner, Maximilian, Dreier, Esther, Maier, Lars, Kusumastuti, Neurinda Permata, McCloskey, Colin, Dabaliz, Al-Awwab, Elshazly, Tarek B, Smith, Josiah, Szuldrzynski, Konstanty S, Bielański, Piotr, Hakeem, Yusuff, Wille, Keith, Holt, Rebecca, Parhar, Ken Kuljit S, Fiest, Kirsten M, Codan, Cassidy, Shahid, Anmol, Fayed, Mohamed, Evans, Timothy, Garcia, Rebekah, Gutierrez, Ashley, Song, Tae, Rose, Rebecca, Bennett, Suzanne, Richardson, Denise, Lopez-Colon, Dalia, Arora, Lovkesh, Rappapport, Kristina, Rudolph, Kristina, Sibenaller, Zita, Stout, Lori, Walter, Alicia, Herr, Daniel, Vedadi, Nazli, Sindt, Lace, Ewald, Cale, Hoffman, Julie, Rajnic, Sean, Thompson, Shaun, Kennedy, Ryan, Griffee, Matthew, Ciullo, Anna, Kida, Yuri, Roca, Ricard Ferrer, Alegre, Cynthia, Contreras, Sofia, Riera, Jordi, Kay, Christy, Fischer, Irene, Renner, Elizabeth, Taniguci, Hayato, Abbate, Gabriella, Hassan, Halah, Karnik, Varun A, Ki, Katrina, O'Neill, Hollier F, Obonyo, Nchafatso, Pimenta, Leticia Pretti, Reid, Janice D, Sato, Kei, Vuorinen, Aapeli, Wildi, Karin S, Wood, Emily S, Yerkovich, Stephanie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2022
Materias:
Research
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9065544/
https://www.ncbi.nlm.nih.gov/pubmed/35508314
http://dx.doi.org/10.1136/bmj-2021-068723
Descripción
Sumario: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.

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