Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA.
Department of Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
J Med Virol. 2023 Jul;95(7):e28961. doi: 10.1002/jmv.28961.
Extracorporeal membrane oxygenation (ECMO) has been used for COVID-19-associated acute respiratory distress syndrome (ARDS). We aimed to elucidate the association between ECMO and mortality in patients with COVID-19-associated ARDS in the nationwide setting. United States National Inpatient Sample was used to identify mechanically ventilated adults for COVID-19 with ARDS. We divided them into three groups according to the use of ECMO (i.e., no-ECMO, venovenous [VV]-ECMO, and venoarterial [VA]-ECMO). The primary outcome was in-hospital mortality, while the secondary outcomes included the length of hospital stay (LOS) and the total costs during hospitalization. We performed a stepwise logistic regression, adjusting for baseline characteristics, comorbidities, and severity. We included 68 795 (mean age [SD]: 63.5 [0.1]), 3280 (mean age [SD]: 48.7 [0.5]), and 340 (mean age [SD]: 43.3 [2.1]) patients who received no-, VV-, and VA-ECMO, respectively. The logistic regression analysis did not show significant associations between the use of VV-/VA-ECMO and mortality (adjusted odds ratio with no-ECMO as reference [95% confidence interval]: 1.03 [0.86-1.24] and 1.18 [0.64-2.15], respectively). While LOS was longest with VV-ECMO, the total costs were highest with VA-ECMO. In conclusion, our study found no association between the use of ECMO and mortality of COVID-19-associated ARDS in the nationwide setting.
体外膜肺氧合（ECMO）已用于 COVID-19 相关的急性呼吸窘迫综合征（ARDS）。我们旨在阐明在全国范围内 ECMO 与 COVID-19 相关 ARDS 患者死亡率之间的关系。我们使用美国国家住院患者样本确定患有 COVID-19 合并 ARDS 的机械通气成年人。我们根据 ECMO 的使用情况将他们分为三组（即无 ECMO、静脉-静脉 [VV]-ECMO 和静脉-动脉 [VA]-ECMO）。主要结局是院内死亡率，次要结局包括住院时间（LOS）和住院期间的总费用。我们进行了逐步逻辑回归，调整了基线特征、合并症和严重程度。我们纳入了 68795 名（平均年龄 [SD]：63.5 [0.1]）、3280 名（平均年龄 [SD]：48.7 [0.5]）和 340 名（平均年龄 [SD]：43.3 [2.1]）分别接受无、VV-和 VA-ECMO 的患者。逻辑回归分析显示，VV-/VA-ECMO 的使用与死亡率之间无显著关联（以无 ECMO 为参考的校正比值比 [95%置信区间]：1.03 [0.86-1.24] 和 1.18 [0.64-2.15]）。虽然 VV-ECMO 的 LOS 最长，但 VA-ECMO 的总费用最高。总之，我们的研究在全国范围内未发现 ECMO 与 COVID-19 相关 ARDS 死亡率之间存在关联。
