Rodrigo A Diaz1, Jerónimo Graf2,3, José M Zambrano4, Carolina Ruiz5,6, Juan A Espinoza7, Sebastian I Bravo6, Pablo A Salazar8, Juan C Bahamondes9,10, Luis B Castillo11, Abraham I J Gajardo12, Andrés Kursbaum13, Leonila L Ferreira14, Josefa Valenzuela15, Roberto E Castillo1, Rodrigo A Pérez-Araos2,3, Marcela Bravo4, Andrés F Aquevedo5,6, Mauricio G González16, Rodrigo Pereira8, Leandro Ortega17, César Santis11, Paula A Fernández14, Vilma Cortés18, Rodrigo A Cornejo12,19. 1. Unidad de Oxigenación por Membrana Extracorpórea, Clínica Las Condes, Santiago, Chile. 2. Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile. 3. Facultad de Medicina, Clínica Alemana-Universidad de Desarrollo, Santiago, Chile. 4. Instituto Nacional del Tórax, Santiago, Chile. 5. Unidad de Paciente Crítico, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile. 6. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 7. Unidad de Cirugía Cardiaca, Departamento Cardiovascular. 8. Equipo de Oxigenación por Membrana Extracorpórea, Hospital de Las Higueras de Talcahuano, Talcahuano, Chile. 9. Servicio de Cirugía Cardiovascular and. 10. Departamento de Cirugía, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile. 11. Unidad de Pacientes Críticos, Hospital Barros Luco Trudeau, Santiago, Chile. 12. Unidad de Pacientes Críticos, Departamento de Medicina, and. 13. Departamento de Cirugía Cardiaca, Clínica Dávila, Santiago, Chile. 14. Unidad de Pacientes Críticos, Hospital Regional de Concepción, Concepción, Chile. 15. Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile. 16. Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universidad de Chile, Santiago, Chile. 17. Unidad de Pacientes Críticos, Hospital Regional de Temuco, Temuco, Chile. 18. División de Gestión de Redes Asistenciales, Ministerio de Salud de Chile, Santiago, Chile; and. 19. Center of Acute Respiratory Critical Illness, Santiago, Chile.
Abstract
Rationale: The role of and needs for extracorporeal membrane oxygenation (ECMO) at a population level during the coronavirus disease (COVID-19) pandemic have not been completely established. Objectives: To identify the cumulative incidence of ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported patients with COVID-19. Methods: We conducted a population-based study from March 3 to August 31, 2020, using linked data from national agencies. The cumulative incidence of ECMO use and mortality risk of ECMO-supported patients were calculated and age standardized. In addition, a retrospective cohort analysis was performed. Outcomes were 90-day mortality after ECMO initiation, ECMO-associated complications, and hospital length of stay. Cox regression models were used to explore risk factors for mortality in a time-to-event analysis. Measurements and Main Results: Ninety-four patients with COVID-19 were supported with ECMO (0.42 per population of 100,000, 14.89 per 100,000 positive cases, and 1.2% of intubated patients with COVID-19); 85 were included in the cohort analysis, and the median age was 48 (interquartile range [IQR], 41-55) years, 83.5% were men, and 42.4% had obesity. The median number of pre-ECMO intubation days was 4 (IQR, 2-7), the median PaO2/FiO2 ratio was 86.8 (IQR, 64-99) mm Hg, 91.8% of patients were prone positioned, and 14 patients had refractory respiratory acidosis. Main complications were infections (70.6%), bleeding (38.8%), and thromboembolism (22.4%); 52 patients were discharged home, and 33 died. The hospital length of stay was a median of 50 (IQR, 24-69) days. Lower respiratory system compliance and higher driving pressure before ECMO initiation were associated with increased mortality. A duration of pre-ECMO intubation ≥10 days was not associated with mortality. Conclusions: Documenting nationwide ECMO needs may help in planning ECMO provision for future COVID-19 pandemic waves. The 90-day mortality of the Chilean cohort of ECMO-supported patients with COVID-19 (38.8%) is comparable to that of previous reports.
Rationale: The role of and needs for extracorporeal membrane oxygenation (ECMO) at a population level during the coronavirus disease (COVID-19) pandemic have not been completely established. Objectives: To identify the cumulative incidence of ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported patients with COVID-19. Methods: We conducted a population-based study from March 3 to August 31, 2020, using linked data from national agencies. The cumulative incidence of ECMO use and mortality risk of ECMO-supported patients were calculated and age standardized. In addition, a retrospective cohort analysis was performed. Outcomes were 90-day mortality after ECMO initiation, ECMO-associated complications, and hospital length of stay. Cox regression models were used to explore risk factors for mortality in a time-to-event analysis. Measurements and Main Results: Ninety-four patients with COVID-19 were supported with ECMO (0.42 per population of 100,000, 14.89 per 100,000 positive cases, and 1.2% of intubated patients with COVID-19); 85 were included in the cohort analysis, and the median age was 48 (interquartile range [IQR], 41-55) years, 83.5% were men, and 42.4% had obesity. The median number of pre-ECMO intubation days was 4 (IQR, 2-7), the median PaO2/FiO2 ratio was 86.8 (IQR, 64-99) mm Hg, 91.8% of patients were prone positioned, and 14 patients had refractory respiratory acidosis. Main complications were infections (70.6%), bleeding (38.8%), and thromboembolism (22.4%); 52 patients were discharged home, and 33 died. The hospital length of stay was a median of 50 (IQR, 24-69) days. Lower respiratory system compliance and higher driving pressure before ECMO initiation were associated with increased mortality. A duration of pre-ECMO intubation ≥10 days was not associated with mortality. Conclusions: Documenting nationwide ECMO needs may help in planning ECMO provision for future COVID-19 pandemic waves. The 90-day mortality of the Chilean cohort of ECMO-supported patients with COVID-19 (38.8%) is comparable to that of previous reports.
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Authors: Ahmed A Rabie; Mohamed H Azzam; Abdulrahman A Al-Fares; Akram Abdelbary; Hani N Mufti; Ibrahim F Hassan; Arpan Chakraborty; Pranay Oza; Alyaa Elhazmi; Huda Alfoudri; Suneel Kumar Pooboni; Abdulrahman Alharthy; Daniel Brodie; Bishoy Zakhary; Kiran Shekar; Marta Velia Antonini; Nicholas A Barrett; Giles Peek; Alain Combes; Yaseen M Arabi Journal: Intensive Care Med Date: 2021-06-22 Impact factor: 17.440