Multi-institutional Analysis of 200 COVID-19 Patients treated with ECMO:Outcomes and Trends
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.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Jacobs et al., 6 Jul 2021, prospective, USA, peer-reviewed, 14 authors.
Abstract: ª 2021 by The Society of Thoracic Surgeons
Published by Elsevier Inc.
0003-4975/$36.00
1
https://doi.org/10.1016/j.athoracsur.2021.06.026
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
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