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0 0.5 1 1.5 2+ Mortality 7% Improvement Relative Risk Jacobs et al. HCQ for COVID-19 LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Prospective study of 200 patients in the USA No significant difference in mortality Jacobs et al., The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2021.06.026 Favors HCQ Favors control
Multi-institutional Analysis of 200 COVID-19 Patients treated with ECMO:Outcomes and Trends
Jacobs et al., The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2021.06.026
Jacobs et al., Multi-institutional Analysis of 200 COVID-19 Patients treated with ECMO:Outcomes and Trends, The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2021.06.026
Jul 2021   Source   PDF  
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Prospective study of 200 ECMO patients showing no significant difference in unadjusted results for HCQ treatment. Time based confounding is likely because HCQ became increasingly controversial and less used over the time covered (as shown in figure 4), while overall treatment protocols during this period improved dramatically, i.e., more control patients likely come later in the period when treatment protocols were greatly improved. This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details; substantial confounding by time likely due to declining usage over the early stages of the pandemic when overall treatment protocols improved dramatically.
risk of death, 6.6% lower, RR 0.93, p = 0.74, treatment 24 of 46 (52.2%), control 86 of 154 (55.8%), NNT 27.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Jacobs et al., 6 Jul 2021, prospective, USA, peer-reviewed, 14 authors.
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Abstract: ª 2021 by The Society of Thoracic Surgeons Published by Elsevier Inc. 0003-4975/$36.00 1 Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends Jeffrey P. Jacobs, MD, Alfred H. Stammers, MSA, CCP (Emeritus), James D. St Louis, MD, J. W. Awori Hayanga, MD, Michael S. Firstenberg, MD, Linda B. Mongero, CCP (Emeritus), Eric A. Tesdahl, PhD, Keshava Rajagopal, MD, PhD, Faisal H. Cheema, MD, Kirti Patel, CCP, Tom Coley, CCP, Anthony K. Sestokas, PhD, Marvin J. Slepian, MD, and Vinay Badhwar, MD Medical Department, SpecialtyCare, Inc, Nashville, Tennessee (JPJ, AHS, LBM, EAT, KP, TC, AKS); Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida (JPJ); Children’s Hospital of Georgia, Augusta, Georgia (JDSL); Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia (JWAH, VB); Medical Center of Aurora, Aurora, Colorado (MSF); University of Houston, Houston, Texas (KR, FHC); HCA Research Institute, Nashville, Tennessee (FHC); and University of Arizona, Tucson, Arizona (MJS) ABSTRACT BACKGROUND The role of extracorporeal membrane oxygenation (ECMO) in the management of patients with COVID19 continues to evolve. The purpose of this analysis is to review our multi-institutional clinical experience involving 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. METHODS This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 1, 2020. Differences by mortality group were assessed using c2 tests for categoric variables and Kruskal-Wallis rank sum tests and Welch’s analysis of variance for continuous variables. RESULTS Median ECMO time was 15 days (interquartile range, 9 to 28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with venovenous ECMO was 87 of 188 patients (46.3%), whereas survival with venoarterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, P < .001) and shorter median time from diagnosis to ECMO cannulation (8 versus 12 days, P [ .003). For the 90 survivors, adjunctive therapies on ECMO included intravenous steroids (64), remdesivir (49), convalescent plasma (43), anti-interleukin-6 receptor blockers (39), prostaglandin (33), and hydroxychloroquine (22). CONCLUSIONS Extracorporeal membrane oxygenation facilitates survival of select critically ill patients with COVID-19. Survivors tend to be younger and have a shorter duration from diagnosis to cannulation. Substantial variation exists in drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy. (Ann Thorac Surg 2021;-:---) ª 2021 by The Society of Thoracic Surgeons A s of January 28, 2021, 100,986,160 patients around the world have been diagnosed with Drs Sestokas and Stammers disclose a financial relationship with SpecialtyCare. Coronavirus Disease 2019 (COVID-19), with 2,177,611 associated deaths (2.16% mortality worldwide).1 Meanwhile, in the United States, as of January 28, 2021, 25,599,961 patients have been diagnosed with The Supplemental..
Late treatment
is less effective
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