Scientific Reports (Jun 2024)

ECMO is associated with decreased hospital mortality in COVID-19 ARDS

  • Won-Young Kim,
  • Sun-Young Jung,
  • Jeong-Yeon Kim,
  • Ganghee Chae,
  • Junghyun Kim,
  • Joon-Sung Joh,
  • Tae Yun Park,
  • Ae-Rin Baek,
  • Yangjin Jegal,
  • Chi Ryang Chung,
  • Jinwoo Lee,
  • Young-Jae Cho,
  • Joo Hun Park,
  • Jung Hwa Hwang,
  • Jin Woo Song

DOI
https://doi.org/10.1038/s41598-024-64949-x
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 10

Abstract

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Abstract This study determined whether compared to conventional mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) is associated with decreased hospital mortality or fibrotic changes in patients with COVID-19 acute respiratory distress syndrome. A cohort of 72 patients treated with ECMO and 390 with conventional MV were analyzed (February 2020–December 2021). A target trial was emulated comparing the treatment strategies of initiating ECMO vs no ECMO within 7 days of MV in patients with a PaO2/FiO2 < 80 or a PaCO2 ≥ 60 mmHg. A total of 222 patients met the eligibility criteria for the emulated trial, among whom 42 initiated ECMO. ECMO was associated with a lower risk of hospital mortality (hazard ratio [HR], 0.56; 95% confidence interval [CI] 0.36–0.96). The risk was lower in patients who were younger (age < 70 years), had less comorbidities (Charlson comorbidity index < 2), underwent prone positioning before ECMO, and had driving pressures ≥ 15 cmH2O at inclusion. Furthermore, ECMO was associated with a lower risk of fibrotic changes (HR, 0.30; 95% CI 0.11–0.70). However, the finding was limited due to relatively small number of patients and differences in observability between the ECMO and conventional MV groups.