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0 0.5 1 1.5 2+ Mortality 7% Improvement Relative Risk HCQ for COVID-19  Jacobs et al.  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 .., Jul 2021 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
Jul 2021  
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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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Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends
MD Jeffrey P Jacobs, MSA, CCP (Emeritus Alfred H Stammers, MD James D St Louis, J W Awori Hayanga, MD Michael S Firstenberg, CCP (Emeritus Linda B Mongero, PhD Eric A Tesdahl, MD Keshava Rajagopal, PhD Faisal H Cheema, MD Kirti Patel, CCP Tom Coley, CCP Anthony K Sestokas, PhD Marvin J Slepian, MD Vinay Badhwar
The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2021.06.026
BACKGROUND The role of extracorporeal membrane oxygenation (ECMO) in the management of patients with COVID-19 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 c 2 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.
Barbaro, Maclaren, Boonstra, Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry, Lancet
Bartlett, Ogino, Brodie, Initial ELSO guidance document: ECMO for COVID-19 patients with severe cardiopulmonary failure, ASAIO J
Clerkin, Fried, Raikhelkar, COVID-19 and cardiovascular disease, Circulation
Henry, COVID-19, ECMO, and lymphopenia: a word of caution, Lancet Respir Med
Jacobs, Falasa, Machuca, Extracorporeal membrane oxygenation for patients with refractory COVID-19: what do we know and what do we need to learn?
Jacobs, Stammers, Louis, Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise 8 JACOBS ET AL ECMO AND COVID-19
Kon, Smith, Chang, Extracorporeal membrane oxygenation support in severe COVID-19, Ann Thorac Surg
Madjid, Safavi-Naeini, Solomon, Vardeny, Potential effects of coronaviruses on the cardiovascular system: a review, JAMA Cardiol
Rajagopal, Keller, Akhanti, Advanced pulmonary and cardiac support of COVID-19 patients: emerging recommendations from ASAIO-a "living working document, ASAIO J
Shih, Dimaio, Squiers, Venovenous extracorporeal membrane oxygenation for patients with refractory COVID-19: multicenter experience of referral hospitals in a large health care system
Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Lancet Respir Med
Late treatment
is less effective
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