Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre matched cohort study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Purpose
Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 (COVID-19). The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality.
Methods
A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques.
Results
1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29–0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre.
Conclusion
We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered.
Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 (COVID-19). The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality.
Methods
A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques.
Results
1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29–0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre.
Conclusion
We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered.
Date Issued
2022-03-03
Date Acceptance
2022-02-07
Citation
Intensive Care Medicine, 2022, 48, pp.467-478
ISSN
0342-4642
Publisher
Springer
Start Page
467
End Page
478
Journal / Book Title
Intensive Care Medicine
Volume
48
Copyright Statement
© 2022 Springer-Verlag GmbH Germany, part of Springer Nature. The final publication is available at Springer via https://doi.org/10.1007/s00134-022-06645-w
Identifier
https://link.springer.com/article/10.1007/s00134-022-06645-w
Subjects
ARDS
COVID-19
ECMO
Severe respiratory failure
COVID-19
Cohort Studies
Extracorporeal Membrane Oxygenation
Humans
Respiratory Distress Syndrome
Retrospective Studies
Humans
Extracorporeal Membrane Oxygenation
Retrospective Studies
Cohort Studies
Respiratory Distress Syndrome
COVID-19
Emergency & Critical Care Medicine
1103 Clinical Sciences
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2022-03-03