Division of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA.
Cardiothoracic Intensive Care Unit, National University Health System, Singapore.
Lancet. 2020 Oct 10;396(10257):1071-1078. doi: 10.1016/S0140-6736(20)32008-0. Epub 2020 Sep 25.
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.
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多个主要的健康组织建议使用体外膜肺氧合（ECMO）支持治疗与 COVID-19 相关的急性低氧性呼吸衰竭。然而，最初报告的 COVID-19 患者使用 ECMO 的情况死亡率非常高，迄今为止，还没有针对 COVID-19 的 ECMO 的大型国际队列研究报告。
我们使用体外生命支持组织（ELSO）登记处的数据，对 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 支持的年龄在 16 岁及以上、确诊为 COVID-19 的患者的流行病学、住院过程和结局进行描述。主要结局是在 ECMO 启动后 90 天的时间到事件分析中评估的院内死亡。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。
这项研究纳入了 1035 名接受 ECMO 支持的 COVID-19 患者的数据。其中，67 名（6%）仍在住院，311 名（30%）出院回家或急性康复中心，101 名（10%）出院至长期急性护理中心或未指明的地点，176 名（17%）出院至另一家医院，380 名（37%）死亡。在 ECMO 启动后 90 天的估计院内死亡率为 37.4%（95%CI 34.4-40.4）。最终死亡或出院的患者的死亡率为 39%（380/968）。ECMO 用于循环支持与院内死亡率较高独立相关（危险比 1.89，95%CI 1.20-2.97）。在接受 COVID-19 呼吸（静脉-静脉）ECMO 并被描述为患有急性呼吸窘迫综合征的患者亚组中，在 ECMO 启动后 90 天的估计院内死亡率为 38.0%（95%CI 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。
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