Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry.
Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry.
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DOI：
10.1016/s0140-6736(20)32008-0
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发表时间：
2020-10-10
期刊：
影响因子：
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通讯作者：
Extracorporeal Life Support Organization
中科院分区：
文献类型：
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作者：
Barbaro RP;MacLaren G;Boonstra PS;Iwashyna TJ;Slutsky AS;Fan E;Bartlett RH;Tonna JE;Hyslop R;Fanning JJ;Rycus PT;Hyer SJ;Anders MM;Agerstrand CL;Hryniewicz K;Diaz R;Lorusso R;Combes A;Brodie D;Extracorporeal Life Support Organization
多个主要卫生组织建议使用体外膜氧合（ECMO）支持与covid -19相关的急性低氧性呼吸衰竭。然而，关于COVID-19患者使用ECMO的初步报告描述了非常高的死亡率，并且迄今为止还没有关于COVID-19患者使用ECMO的大型国际队列研究报告。我们使用来自体外生命支持组织（ELSO）登记处的数据来描述在2020年1月16日至5月1日期间在36个国家的213家医院接受ECMO支持的16岁或以上确诊COVID-19患者的流行病学、住院过程和结局。在ECMO开始后90天进行的时间到事件分析中，主要终点是院内死亡。我们应用多变量Cox模型来检验患者和医院因素是否与院内死亡率相关。本研究纳入了1035例接受ECMO支持的COVID-19患者的数据。其中，67人（6%）继续住院，311人（30%）出院回家或到急性康复中心，101人（10%）出院到长期急性护理中心或未指明地点，176人（17%）出院到另一家医院，380人（37%）死亡。ECMO开始后90天的住院死亡率累积发生率估计为37.4% （95% CI为34.4 - 40.4）。最终死亡或出院的患者死亡率为39%（380 / 968）。使用ECMO进行循环支持与较高的住院死亡率独立相关（风险比1.89,95% CI 1.20 - 2.97）。在接受呼吸（静脉-静脉）ECMO并以急性呼吸窘迫综合征为特征的COVID-19患者亚组中，ECMO开始后90天的住院死亡率累积发生率估计为38.0% （95% CI为34.6 - 41.5）。在接受ECMO的COVID-19患者中，ECMO后90天的估计死亡率和最终死亡或出院的死亡率均低于40%。这些来自全球213家医院的数据提供了COVID-19背景下ECMO死亡率的一般估计。没有。
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. 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. 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). 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. None.