Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19
the STOP-COVID Investigators, Shahzad Shaefi, Samantha K. Brenner, Shruti Gupta, Brian O’Gara, Megan L. Krajewski, David M. Charytan, Sobaata Chaudhry, Sara Mirza, Vasil Peev, Mark D. Anderson, Anip Bansal, Salim S. Hayek, Anand Srivastava, Kusum S. Mathews, Tanya S. Johns, Amanda K. Leonberg‐Yoo, Adam Green, Justin Arunthamakun, Keith Wille, Tanveer Shaukat, Harkarandeep Singh, Andrew J. Admon, Matthew W. Semler, Miguel A. Hernán, Ariel Mueller, Wei Wang, David E. Leaf
Abstract
Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19). We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO 2 /FiO 2 < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model. Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41–58), 137 (72.1%) were men, and the median PaO 2 /FiO 2 prior to ECMO initiation was 72 (IQR 61–90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41–0.74). Results were similar in a secondary analysis limited to patients with PaO 2 /FiO 2 < 80 (HR 0.55; 95% CI 0.40–0.77). In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.