دورية أكاديمية
Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis.
| العنوان: | Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis. |
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| المؤلفون: | Hajage, David, Combes, Alain, Guervilly, Christophe, Lebreton, Guillaume, Mercat, Alain, Pavot, Arthur, Nseir, Saad, Mekontso-Dessap, Armand, Mongardon, Nicolas, Mira, Jean Paul, Ricard, Jean-Damien, Beurton, Alexandra, Tachon, Guillaume, Kontar, Loay, Le Terrier, Christophe, Richard, Jean Christophe, Mégarbane, Bruno, Keogh, Ruth H, Belot, Aurélien, Maringe, Camille, Leyrat, Clémence, Schmidt, Matthieu, COVID-ICU Investigators |
| المساهمون: | Lambermont, Bernard |
| المصدر: | American Journal of Respiratory and Critical Care Medicine, 206 (3), 281 - 294 (2022-08-01) |
| بيانات النشر: | American Thoracic Society, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | COVID-19, SARS-CoV-2, acute respiratory distress syndrome, emulated target trial, extracorporeal membrane oxygenation, Adult, Cohort Studies, Humans, Retrospective Studies, Treatment Outcome, COVID-19/complications, COVID-19/therapy, Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome/etiology, Respiratory Distress Syndrome/therapy, Respiratory Distress Syndrome, Pulmonary and Respiratory Medicine, Critical Care and Intensive Care Medicine, Human health sciences, Anesthesia & intensive care, Sciences de la santé humaine, Anesthésie & soins intensifs |
| الوصف: | Rationale: Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. Objectives: To estimate the effect of ECMO on 90-day mortality versus IMV only. Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO versus no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 < 80 or PaCO2 ⩾ 60 mm Hg). We controlled for confounding using a multivariable Cox model on the basis of predefined variables. Measurements and Main Results: A total of 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability on Day 7 from the onset of eligibility criteria (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0-9%), which decreased during follow-up (survival on Day 90: 63% vs. 65%; risk difference, -2%; 95% confidence interval, -10 to 5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand and when initiated within the first 4 days of IMV and in patients who are profoundly hypoxemic. Conclusions: In an emulated trial on the basis of a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and regions with ECMO capacities specifically organized to handle high demand. |
| نوع الوثيقة: | journal article http://purl.org/coar/resource_type/c_6501Test article peer reviewed |
| اللغة: | English |
| العلاقة: | https://www.atsjournals.org/doi/pdf/10.1164/rccm.202111-2495OCTest; 10.1164/rccm.202111-2495OC; urn:issn:1073-449X; urn:issn:1535-4970 |
| DOI: | 10.1164/rccm.202111-2495OC |
| الوصول الحر: | https://orbi.uliege.be/handle/2268/300778Test |
| حقوق: | open access http://purl.org/coar/access_right/c_abf2Test info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsorb.300778 |
| قاعدة البيانات: | ORBi |
| DOI: | 10.1164/rccm.202111-2495OC |
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