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0 0.5 1 1.5 2+ Mortality 40% Improvement Relative Risk HCQ for COVID-19  Aweimer et al.  INTUBATED PATIENTS Is very late treatment with HCQ beneficial for COVID-19? Retrospective 149 patients in Germany (March 2020 - August 2021) Lower mortality with HCQ (not stat. sig., p=0.12) c19hcq.org Aweimer et al., Scientific Reports, Mar 2023 Favors HCQ Favors control

Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany

Aweimer et al., Scientific Reports, doi:10.1038/s41598-023-31944-7
Mar 2023  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now known with p < 0.00000000001 from 422 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,100+ studies for 60+ treatments. c19hcq.org
Retrospective 149 patients under invasive mechanical ventilation in Germany showing no significant difference in mortality with HCQ in unadjusted results.
Study covers remdesivir, HCQ, aspirin, and vitamin D.
risk of death, 40.2% lower, RR 0.60, p = 0.12, treatment 4 of 9 (44.4%), control 104 of 140 (74.3%), NNT 3.4.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Aweimer et al., 29 Mar 2023, retrospective, Germany, peer-reviewed, median age 67.0, 19 authors, study period 1 March, 2020 - 31 August, 2021.
This PaperHCQAll
Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany
Assem Aweimer, Lea Petschulat, Birger Jettkant, Roland Köditz, Johannes Finkeldei, Johannes W Dietrich, Thomas Breuer, Christian Draese, Ulrich H Frey, Tim Rahmel, Michael Adamzik, Dirk Buchwald, Dritan Useini, Thorsten Brechmann, Ingolf Hosbach, Jürgen Bünger, Aydan Ewers, Ibrahim El-Battrawy, Andreas Mügge
Scientific Reports, doi:10.1038/s41598-023-31944-7
The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients' outcome in severe COVID-19 with respiratory failure, but data on ECMO remains controversial. The aim of the study was to determine the characteristics of patients under invasive mechanical ventilation (IMV) with or without veno-venous ECMO support and to evaluate outcome parameters. Ventilated patients with COVID-19 with and without additional ECMO support were analyzed in a retrospective multicenter study regarding clinical characteristics, respiratory and laboratory parameters in dayto-day follow-up. Recruitment of patients was conducted during the first three COVID-19 waves at four German university hospitals of the Ruhr University Bochum, located in the Middle Ruhr Region. From March 1, 2020 to August 31, 2021, the charts of 149 patients who were ventilated for COVID-19 infection, were included (63.8% male, median age 67 years). Fifty patients (33.6%) received additional ECMO support. On average, ECMO therapy was initiated 15.6 ± 9.4 days after symptom onset, 10.6 ± 7.1 days after hospital admission, and 4.8 ± 6.4 days after the start of IMV. Male sex and higher SOFA and RESP scores were observed significantly more often in the high-volume ECMO center. Premedication with antidepressants was more often detected in survivors (22.0% vs. 6.5%; p = 0.006). ECMO patients were 14 years younger and presented a lower rate of concomitant cardiovascular
Author contributions A.A. and L.P. take responsibility for the content of the manuscript, including the data and analysis. A.A., A.M., T.R., C.D., T.B., J.F., D.B. contributed to the conception and design of the study. A.A., L.P., B.J., R.K., D.B., A.M. analyzed and interpreted the patient data. A.A., L.P. and B.J. performed the statistical analyses. A.A., A.M., I.E. and TB were major contributors in writing the manuscript. J.D., R.K., D.B., T.R., U.F., M.A., J.B., I.H. contributed to interpretation of the data and revised the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare no competing interests.
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From March 1, 2020 to August 31, 2021, the charts of 149 patients who ' 'were ventilated for COVID-19 infection, were included (63.8% male, median age 67\xa0years). ' 'Fifty patients (33.6%) received additional ECMO support. On average, ECMO therapy was ' 'initiated 15.6\u2009±\u20099.4\xa0days after symptom onset, 10.6\u2009±\u20097.1\xa0days ' 'after hospital admission, and 4.8\u2009±\u20096.4\xa0days after the start of IMV. Male sex ' 'and higher SOFA and RESP scores were observed significantly more often in the high-volume ' 'ECMO center. Pre-medication with antidepressants was more often detected in survivors (22.0% ' 'vs. 6.5%; <jats:italic>p</jats:italic>\u2009=\u20090.006). ECMO patients were 14\xa0years ' 'younger and presented a lower rate of concomitant cardiovascular diseases (18.0% vs. 47.5%; ' '<jats:italic>p</jats:italic>\u2009=\u20090.0004). Additionally, cytokine-adsorption (46.0% ' 'vs. 13.1%; <jats:italic>p</jats:italic>\u2009&lt;\u20090.0001) and renal replacement therapy ' '(76.0% vs. 43.4%; <jats:italic>p</jats:italic>\u2009=\u20090.0001) were carried out more ' 'frequently; in ECMO patients thrombocytes were transfused 12-fold more often related to more ' 'than fourfold higher bleeding complications. Undulating C-reactive protein (CRP) and massive ' 'increase in bilirubin levels (at terminal stage) could be observed in deceased ECMO patients. ' 'In-hospital mortality was high (Overall: 72.5%, ECMO: 80.0%, ns). Regardless of ECMO therapy ' 'half of the study population deceased within 30\xa0days after hospital admission. Despite ' 'being younger and with less comorbidities ECMO therapy did not improve survival in severely ' 'ill COVID-19 patients. Undulating CRP levels, a massive increase of bilirubin level and a ' 'high use of cytokine-adsorption were associated with worse outcomes. 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' '16(5), 235. https://doi.org/10.1186/cc11381 (2012).', 'volume': '16', 'year': '2012'}, { 'DOI': '10.1016/S2213-2600(20)30119-3', 'author': 'BM Henry', 'doi-asserted-by': 'publisher', 'first-page': 'e24', 'issue': '4', 'journal-title': 'Lancet Respir. Med.', 'key': '31944_CR48', 'unstructured': 'Henry, B. M. COVID-19, ECMO, and lymphopenia: A word of caution. Lancet ' 'Respir. Med. 8(4), e24. https://doi.org/10.1016/S2213-2600(20)30119-3 ' '(2020).', 'volume': '8', 'year': '2020'}, { 'DOI': '10.1097/PCC.0b013e3181e28894', 'author': 'MJ Bizzarro', 'doi-asserted-by': 'publisher', 'first-page': '277', 'issue': '3', 'journal-title': 'Pediatr. Crit. Care Med.', 'key': '31944_CR49', 'unstructured': 'Bizzarro, M. J. et al. Infections acquired during extracorporeal ' 'membrane oxygenation in neonates, children, and adults. Pediatr. Crit. ' 'Care Med. 12(3), 277–281. https://doi.org/10.1097/PCC.0b013e3181e28894 ' '(2011).', 'volume': '12', 'year': '2011'}, { 'DOI': '10.1111/bjh.17007', 'author': 'AJ Doyle', 'doi-asserted-by': 'publisher', 'first-page': '382', 'issue': '3', 'journal-title': 'Br. J. Haematol.', 'key': '31944_CR50', 'unstructured': 'Doyle, A. J. et al. Blood component use in critical care in patients ' 'with COVID-19 infection: A single-centre experience. Br. J. Haematol. ' '191(3), 382–385. https://doi.org/10.1111/bjh.17007 (2020).', 'volume': '191', 'year': '2020'}], 'reference-count': 50, 'references-count': 50, 'relation': {}, 'resource': {'primary': {'URL': 'https://www.nature.com/articles/s41598-023-31944-7'}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subject': ['Multidisciplinary'], 'subtitle': [], 'title': 'Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal ' 'membrane oxygenation in the Middle Ruhr Region of Germany', 'type': 'journal-article', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'volume': '13'}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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