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      Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study

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          Abstract

          Purpose

          Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 (COVID-19). The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality.

          Methods

          A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques.

          Results

          1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29–0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre.

          Conclusion

          We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00134-022-06645-w.

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          Most cited references37

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          Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.

          Giacomo Bellani, John Laffey, Tài Pham … (2016)
          Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).
          Article 0 comments Cited 1357 times – based on 0 reviews     Review now
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            Sensitivity Analysis in Observational Research: Introducing the E-Value.

            Peng Ding, Tyler J. VanderWeele (2017)
            Sensitivity analysis is useful in assessing how robust an association is to potential unmeasured or uncontrolled confounding. This article introduces a new measure called the "E-value," which is related to the evidence for causality in observational studies that are potentially subject to confounding. The E-value is defined as the minimum strength of association, on the risk ratio scale, that an unmeasured confounder would need to have with both the treatment and the outcome to fully explain away a specific treatment-outcome association, conditional on the measured covariates. A large E-value implies that considerable unmeasured confounding would be needed to explain away an effect estimate. A small E-value implies little unmeasured confounding would be needed to explain away an effect estimate. The authors propose that in all observational studies intended to produce evidence for causality, the E-value be reported or some other sensitivity analysis be used. They suggest calculating the E-value for both the observed association estimate (after adjustments for measured confounders) and the limit of the confidence interval closest to the null. If this were to become standard practice, the ability of the scientific community to assess evidence from observational studies would improve considerably, and ultimately, science would be strengthened.
            Article 0 comments Cited 1335 times – based on 0 reviews     Review now
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              MatchIt: Nonparametric Preprocessing for Parametric Causal Inference

              Daniel Ho, Kosuke Imai, Gary King … (2011)
              Article 0 comments Cited 1061 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Stephen Whebell:
                ORCID: http://orcid.org/0000-0002-2604-8657
                swhebell@gmail.com
                Journal
                Journal ID (nlm-ta): Intensive Care Med
                Journal ID (iso-abbrev): Intensive Care Med
                Title: Intensive Care Medicine
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0342-4642
                ISSN (Electronic): 1432-1238
                Publication date (Electronic): 3 March 2022
                Pages: 1-12
                Affiliations
                [1 ]GRID grid.420545.2, ISNI 0000 0004 0489 3985, Department of Adult Critical Care, , Guy’s and St Thomas’ NHS Foundation Trust, ; London, UK
                [2 ]GRID grid.429705.d, ISNI 0000 0004 0489 4320, Department of Critical Care, , King’s College Hospital NHS Foundation Trust, ; London, UK
                [3 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Institute of Global Health Innovation, , Imperial College London, ; London, UK
                [4 ]GRID grid.421662.5, ISNI 0000 0000 9216 5443, Department of Adult Intensive Care, , Royal Brompton and Harefield NHS Foundation Trust, ; London, UK
                [5 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Division of Asthma, Allergy and Lung Biology, , King’s College London, ; London, UK
                [6 ]GRID grid.425213.3, Department of Adult Critical Care, , St Thomas’ Hospital, ; London, SE1 7EH UK
                Author information
                http://orcid.org/0000-0002-2604-8657
                Article
                Publisher ID: 6645
                DOI: 10.1007/s00134-022-06645-w
                PMC ID: 8892395
                PubMed ID: 35238946
                SO-VID: 718af018-77b8-4972-98c8-f748aff089fc
                Copyright © © Springer-Verlag GmbH Germany, part of Springer Nature 2022
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 29 November 2021
                Date accepted : 7 February 2022
                Categories
                Subject: Original

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: ecmo,covid-19,ards,severe respiratory failure
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: ecmo, covid-19, ards, severe respiratory failure

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