Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis
2019-20 coronavirus outbreak
Coronavirus
Rescue therapy
DOI:
10.1164/rccm.202111-2495oc
Publication Date:
2022-05-09T16:03:39Z
AUTHORS (576)
ABSTRACT
Rationale: Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared conventional invasive mechanical ventilation (IMV) remains unknown. Objectives: To estimate the effect of ECMO on 90-day mortality versus IMV only. Methods: Among 4,244 critically ill adult COVID-19 included in a multicenter cohort study, we emulated target trial comparing treatment strategies initiating no within 7 days severe acute respiratory distress syndrome (PaO2/FiO2 < 80 or PaCO2 ⩾ 60 mm Hg). We controlled for confounding using multivariable Cox model basis predefined variables. Measurements and Main Results: A total 1,235 met full eligibility criteria trial, among whom 164 initiated ECMO. The strategy had higher survival probability Day onset (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0–9%), which decreased during follow-up (survival 90: 63% 65%; −2%; −10 to 5%). However, was associated when performed high-volume centers regions where specific network organization set up handle high demand first 4 who are profoundly hypoxemic. Conclusions: In an nationwide cohort, found differential over time no-ECMO strategy. consistently better outcomes capacities specifically organized demand.
SUPPLEMENTAL MATERIAL
Coming soon ....
REFERENCES (35)
CITATIONS (43)
EXTERNAL LINKS
PlumX Metrics
RECOMMENDATIONS
FAIR ASSESSMENT
Coming soon ....
JUPYTER LAB
Coming soon ....