Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19 An Emulated Target Trial Analysis

  1. Hajage, David
  2. Combes, Alain
  3. Guervilly, Christophe
  4. Lebreton, Guillaume
  5. Mercat, Alain
  6. Pavot, Arthur
  7. Nseir, Saad
  8. Mekontso-Dessap, Armand
  9. Mongardon, Nicolas
  10. Mira, Jean Paul
  11. Ricard, Jean-Damien
  12. Beurton, Alexandra
  13. Tachon, Guillaume
  14. Kontar, Loay
  15. Le Terrier, Christophe
  16. Richard, Jean Christophe
  17. Megarbane, Bruno
  18. Keogh, Ruth H.
  19. Belot, Aurélien
  20. Maringe, Camille
  21. Leyrat, Clémence ORCID logo
  22. SCHMIDT, Matthieu ORCID logo

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1000 Titel
  • Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19 An Emulated Target Trial Analysis
1000 Autor/in
  1. Hajage, David |
  2. Combes, Alain |
  3. Guervilly, Christophe |
  4. Lebreton, Guillaume |
  5. Mercat, Alain |
  6. Pavot, Arthur |
  7. Nseir, Saad |
  8. Mekontso-Dessap, Armand |
  9. Mongardon, Nicolas |
  10. Mira, Jean Paul |
  11. Ricard, Jean-Damien |
  12. Beurton, Alexandra |
  13. Tachon, Guillaume |
  14. Kontar, Loay |
  15. Le Terrier, Christophe |
  16. Richard, Jean Christophe |
  17. Megarbane, Bruno |
  18. Keogh, Ruth H. |
  19. Belot, Aurélien |
  20. Maringe, Camille |
  21. Leyrat, Clémence |
  22. SCHMIDT, Matthieu |
1000 Mitwirkende/r
  1. COVID-ICU Investigators |
1000 Erscheinungsjahr 2022
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2022-08
1000 Erschienen in
1000 Quellenangabe
  • 206(3):281-294
1000 Copyrightjahr
  • 2022
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1164/rccm.202111-2495OC |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9890253/ |
1000 Ergänzendes Material
  • https://www.atsjournals.org/doi/suppl/10.1164/rccm.202111-2495OC |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • 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 Pa-CO2 >= 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, 22%; 95% confidence interval, 210 to 5%). However, ECMO was associated with higher survival when performed in highvolume 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.
1000 Sacherschließung
lokal emulated target trial
gnd 1206347392 COVID-19
lokal acute respiratory distress syndrome
lokal SARS-CoV-2
lokal extracorporeal membrane oxygenation
1000 Fächerklassifikation (DDC)
1000 Liste der Beteiligten
  1. https://frl.publisso.de/adhoc/uri/SGFqYWdlLCBEYXZpZA==|https://frl.publisso.de/adhoc/uri/Q29tYmVzLCBBbGFpbg==|https://frl.publisso.de/adhoc/uri/R3VlcnZpbGx5LCBDaHJpc3RvcGhl|https://frl.publisso.de/adhoc/uri/TGVicmV0b24sIEd1aWxsYXVtZQ==|https://frl.publisso.de/adhoc/uri/TWVyY2F0LCBBbGFpbg==|https://frl.publisso.de/adhoc/uri/UGF2b3QsIEFydGh1cg==|https://frl.publisso.de/adhoc/uri/TnNlaXIsIFNhYWQ=|https://frl.publisso.de/adhoc/uri/TWVrb250c28tRGVzc2FwLCBBcm1hbmQ=|https://frl.publisso.de/adhoc/uri/TW9uZ2FyZG9uLCBOaWNvbGFz|https://frl.publisso.de/adhoc/uri/TWlyYSwgSmVhbiBQYXVs|https://frl.publisso.de/adhoc/uri/UmljYXJkLCBKZWFuLURhbWllbg==|https://frl.publisso.de/adhoc/uri/QmV1cnRvbiwgQWxleGFuZHJh|https://frl.publisso.de/adhoc/uri/VGFjaG9uLCBHdWlsbGF1bWU=|https://frl.publisso.de/adhoc/uri/S29udGFyLCBMb2F5|https://frl.publisso.de/adhoc/uri/TGUgVGVycmllciwgQ2hyaXN0b3BoZQ==|https://frl.publisso.de/adhoc/uri/UmljaGFyZCwgSmVhbiBDaHJpc3RvcGhl|https://frl.publisso.de/adhoc/uri/TWVnYXJiYW5lLCBCcnVubw==|https://frl.publisso.de/adhoc/uri/S2VvZ2gsIFJ1dGggSC4=|https://frl.publisso.de/adhoc/uri/QmVsb3QsIEF1csOpbGllbg==|https://frl.publisso.de/adhoc/uri/TWFyaW5nZSwgQ2FtaWxsZQ==|https://orcid.org/0000-0002-4097-4577|https://orcid.org/0000-0002-2931-4412|https://frl.publisso.de/adhoc/uri/Q09WSUQtSUNVIEludmVzdGlnYXRvcnM=
1000 Label
1000 Förderer
  1. Assistance Publique - Hôpitaux de Paris |
  2. Ministère de la Santé et de la Prévention |
  3. Hôpitaux Universitaires de Genève |
  4. Medical Research Council |
  5. UK Research and Innovation |
  6. Cancer Research UK |
1000 Fördernummer
  1. -
  2. -
  3. -
  4. MR/T032448/1
  5. MR/S017968/1
  6. C7923/A29018
1000 Förderprogramm
  1. Alliance Tous Unis Contre le Virus
  2. -
  3. -
  4. Skills Development Fellowship
  5. Future Leaders Fellowship
  6. -
1000 Dateien
1000 Förderung
  1. 1000 joinedFunding-child
    1000 Förderer Assistance Publique - Hôpitaux de Paris |
    1000 Förderprogramm Alliance Tous Unis Contre le Virus
    1000 Fördernummer -
  2. 1000 joinedFunding-child
    1000 Förderer Ministère de la Santé et de la Prévention |
    1000 Förderprogramm -
    1000 Fördernummer -
  3. 1000 joinedFunding-child
    1000 Förderer Hôpitaux Universitaires de Genève |
    1000 Förderprogramm -
    1000 Fördernummer -
  4. 1000 joinedFunding-child
    1000 Förderer Medical Research Council |
    1000 Förderprogramm Skills Development Fellowship
    1000 Fördernummer MR/T032448/1
  5. 1000 joinedFunding-child
    1000 Förderer UK Research and Innovation |
    1000 Förderprogramm Future Leaders Fellowship
    1000 Fördernummer MR/S017968/1
  6. 1000 joinedFunding-child
    1000 Förderer Cancer Research UK |
    1000 Förderprogramm -
    1000 Fördernummer C7923/A29018
1000 Objektart article
1000 Beschrieben durch
1000 @id frl:6435468.rdf
1000 Erstellt am 2022-10-12T13:37:14.379+0200
1000 Erstellt von 329
1000 beschreibt frl:6435468
1000 Bearbeitet von 337
1000 Zuletzt bearbeitet 2023-12-14T11:10:08.088+0100
1000 Objekt bearb. Thu Dec 14 11:10:07 CET 2023
1000 Vgl. frl:6435468
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  1. oai:frl.publisso.de:frl:6435468 |
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