Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis
David HajageAlain CombesChristophe GuervillyGuillaume LebretonAlain MercatArthur PavotSaad NseirArmand Mekontso‐DessapNicolas MongardonJean Paul MiraJean‐Damien RicardAlexandra BeurtonGuillaume TachonLoay KontarChristophe Le TerrierJean‐Christophe RichardBruno MégarbaneRuth H. KeoghAurélien BelotCamille MaringeClémence LeyratMatthieu SchmidtAlain MercatPierre AsfarFrançois BeloncleJulien DemiselleTài PhamArthur PavotXavier MonnetChristian RichardAlexandre DemouleMartin DresJulien MayauxAlexandra BeurtonCédric DaubinRichard DescampsAurélie JoretDamien du CheyronFrédéric PèneJean‐Daniel ChicheMathieu JozwiakPaul JaubertGuillaume VoiriotMuriel FartoukhMarion TeulierClarisse BlayauErwen L’HerCécile AubronLaetitia BodénesNicolas FerrièreJohann AuchabieAnthony Le MeurSylvain PignalThierry MazzoniJean‐Pierre QuenotPascal AndreuJean-Baptiste RoudauMarie LabruyèreSaad NseirSébastien PréauJulien PoissyDaniel MathieuSarah BenhamidaRémi PauletNicolas RoucaudMartial ThyraultFlorence DavietSami HraiechGabriel ParzyAude SylvestreSébastien JochmansAnne-Laure BouillandMehran MonchiMarc Danguy des DésertsQuentin MathaisGwendoline RagerPierre PasquierJean ReignierAmélie SeguinCharlotte GarretEmmanuel CanetJean DellamonicaClément SaccheriRomain LombardiYanis KouchitSophie JacquierArmelle MathonnetMai-Ahn NayIsabelle RungeFrédéric MartinoLaure FlurinAmélie RolleMichel CarlesRémi CoudroyArnaud W. ThilleJean‐Pierre FratMaeva RodriguezPascal BeuretAudrey TientcheuArthur VincentFlorian MichelinFabienne TamionDorothée CarpentierDéborah BoyerG. BéduneauValérie GissotStéphan EhrmannCharlotte Salmon GandonnièreDjlali ElaroussiAgathe DelboveYannick FédunJulien HuntzingerEddy LebasGrâce KisokaCéline GregoireStella MarchettaBernard LambermontLaurent ArgaudThomas BaudryPierre-Jean BertrandAuguste DargentChristophe GuittonNicolas ChudeauMickaël LandaisCédric DarreauAlexis FerréAntoine GrosGuillaume LacaveFabrice BruneelMathilde NeuvilleJérôme DevaquetGuillaume TachonRichard GallotRiad ChelhaArnaud GalboisAnne JallotLudivine Chalumeau LemoineKhaldoun KuteifanValentin PointurierLouise-Marie JandeauxJoy MootienCharles DamoiselBenjamin SztrymfMatthieu SchmidtAlain CombesJuliette ChommelouxCharles Edouard LuytFrédérique SchortgenLeon RuselCamille JungFlorent GobertDamien VimpèreLionel LamhautBertrand SauneufLiliane CharrrierJulien CalusIsabelle DesmeulesBenoît PainvinJean-Marc TadiéVincent CastelainBaptiste MichardJean-Étienne HerbrechtMathieu BaldaciniNicolas WeissSophie DemeretClémence MaroisBenjamin RohautPierre-Henri MouryAnne-Charlotte SavidaEmmanuel CouadauMathieu SèriéNica AlexandruCédric BruelCandice FontaineSonia GarrigouJuliette Courtiade MahlerMaxime LeclercMichel RamakersPierre GarçonNicole MassouLy Van VongJuliane SenNolwenn LucasFrank ChemouniAnnabelle StoclinAlexandre AvenelHenri FaureAngélie GentilhommeSylvie RicomeP. AbrahamCéline MonardJulien TextorisThomas RimmeléFlorent MontiniGabriel LejourThierry LazardIsabelle EtienneyYounes KerroumiClaire DupuisMarine BereiziatElisabeth CoupezFrançois ThouyClément HoffmannNicolas DonatAnne ChrismentRose-Marie BlotAntoine KimmounAudrey JacquotMatthieu MatteiBruno LévyRamin RavanLoïc DopeuxJean-Mathias LiteaudonDelphine Le RouxBrice ReyRadu AnghelDeborah SchenesseVincent GevreyJermy CastaneraPhilippe PetuaBenjamin MadeuxOtto HartmanMichaël PiagnerelliAnne JoostenCindérella NoelPatrick BistonThibaut NoëlGurvan Le BouarMessabi BoukhanzaElsa DemarestMarie-France BajoletNathanaël CharrierAudrey QuenetCécile ZylberfajnNicolas DufourBuno MégarbaneSébastian VoicuNicolas DeyeIsabelle MalissinFrançois LegayMatthieu DébarreNicolas BarbarotPierre FillâtreBertrand DelordThomas LaterradeTahar SaghiWilfried PujolPierre‐Julien CungiPierre EsnaultMickaël CardinaleVivien Hong Tuan HaGrégory FleuryMarie-Ange BrouDaniel ZafimahazoDavid Tran-VanPatrick AvarguesLisa CarencoNicolas RobinAlexandre OualiLucie HoudouChristophe Le TerrierNoémie SuhSteve PrimmazJérôme PuginEmmanuel WeissTobias GaussJean-Denis MoyerCatherine Paugam BurtzBéatrice La CombeRolland SmonigJade ViolleauPauline CailliezJonathan ChellyAntoine MarchalotCécile SaladinChristelle BigotPierre-Marie FayolleJules FatséasAmr IbrahimDabor RésièreRabih HageClémentine CholetMarie CantierPierre TrouilerPhilippe MontraversBrice Lortat‐JacobSébastien TanakaAlexy Tran‐DinhJacques DuranteauAnatole HarroisGuillaume DubreuilMarie WernerAnne GodiérSophie HamadaDiane ZlotnikHélène NougueArmand Mekontso‐DessapGuillaume CarteauxKeyvan RazaziNicolas de ProstNicolas MongardonMeriam LamraouiClaire AlessandriQuentin de RouxCharles de RoquetailladeBenjamin G. ChoustermanAlexandre MebazaaÉtienne GayatMarc GarnierEmmanuel PardoLéa Satre-BuissonChristophe GuttonElise YvinClémence MarcaultÉlie AzoulayMichaël DarmonHafid Ait‐OufellaGeoffroy HaririTomas UrbinaSandie MazerandNicholas HemingFrancesca De SantiPierre MoineDjillali AnnaneAdrien BougléEdris OmarAymeric LancelotEmmanuelle BégotGaëtan PlantefèveDamien ContouHervé MentecOlivier PajotStanislas FaguerOlivier CointaultLaurence LavayssièreMarie‐Béatrice NogierMatthieu JammeClaire PichereauJan HayonHervé OutinFrançois DépretMaxime CoutrotMaïté ChaussardLucie GuillemetPierre GoffinRomain ThounyJulien GuntzLaurent JadotRomain PersichiniVanessa Jean-MichelHugues GeorgesThomas CaulierGaël PradelMarie-Hélène HausermannThi My Hue Nguyen-ValatMichel BoudinaudEmmanuel VivierSylvène RosseliGaël BourdinChristian PommierMarc VinclairSimon PoignantSandrine MonsWulfran BougouinFranklin BrunaQuentin MaestraggiChristian RothLaurent BitkerFrançois DhelftJustine Bonnet-ChateauMathilde FilippelliTristan Morichau-BeauchantStéphane ThierryCharlotte RoyMélanie Saint JouanBruno GonçalvesAurélien MazeraudMatthieu DanielTarek SharsharCyril CadozRostane GaciSébastien GetteGuillaune LouisSophe-Caroline SacleuxMarie‐Amélie OrdanAurélie CravoisyMarie ConradGuilhem CourteSébastien GibotYounès BenzidiClaudia CasellaLaurent SerpinJean-Lou SettiMarie-Catherine BesseAnna BourreauJérôme PillotCaroline RiveraCamille VinclairMarie-Aline RobauxChloé AchinoMarie‐Charlotte DelignetteTessa MazardFrédéric AubrunBruno BouchetAurélien FrérouLaura MüllerCharlotte QuentinSamuel DegoulXavier StihleClaude SumianNicoletta BergeroBernard LanaspreHervé QuintardEve Marie MaizierePierre-Yves EgreteauGuillaume LeloupFlorin BerteauMarjolaine CottrelMarie BouteloupMatthieu JeannotQuentin BlancJulien SaisonIsabelle GeneauRomaric GrenotAbdel OuchikePascal HazeraAnne-Lyse MasseSuela DemiriCorinne VézinetĖlodie BaronDéborah BenchetritAntoine MonselGrégoire TrebbiaEmmanuelle SchaackRaphaël LepecqMathieu BobetChristophe VinsonneauThibault DekeyserQuentin DelforgeImen RahmaniBérengère VivetJonathan PaillotLucie HierleClaire ChaignatSarah ValetteBenoït HerJennifier BrunetMathieu PageFabienne BoisteAnthony CollinFlorent BavozetA. GarinMohamed DlalaKais MhamdiBassem BeilounyAlexandra LavalardSeverine PerezBenoît VeberPierre‐Gildas GuitardPhilippe GouinAnna LamaczFabienne PlouvierBertrand P. DelabordeAïssa KherchacheAmina ChaalalJean‐Damien RicardMarc AmourettiSantiago Freita-RamosDamien RouxJean-Michel ConstantinMona AssefiMarine LecoreAgathe SelvesFlorian PrevostChristian LamerRuiying ShiLyes KnaniSébastien Pili FlouryLucie VettorettiMichaël LévyLucile MarsacStéphane DaugerSophie Guilmin‐CréponHadrien WiniszewskiGaël PitonThibaud SoumagneGilles CapellierJean-Baptiste PutegnatFrédérique BayleMaya PerrouGhyslaine ThaoGuillaume GériCyril CharronXavier RepesséAntoine Vieillard-BaronMathieu GuilbartPierre-Alexandre RogerSébastien HinardPierre-Yves MacqKevin ChaulierSylvie GouttePatrick ChilletAnaïs PittaBarbara DarjentAmandine BruneauSigismond LasockiMaxime LégerSoizic GergaudPierre LemariéNicolas TerziCarole SchwebelAnaïs DartevelLouis-Marie GalerneauJean‐Luc DiehlCaroline Hauw‐BerlemontNicolas PéronEmmanuel GuérotAbolfazl Mohebbi AmoliMichel BenhamouJean-Pierre DeymeOlivier AndremontDiane LenaJulien CadyArnaud CauseretArnaud De La ChapelleChristophe CraccoStéphane RouleauDavid SchnellCamille FoucaultCécile LoryThibault ChapelleVincent BruckertJulie GarciaAbdlazize SahraouiNathalie AbboshCaroline BornstainPierre PernetFlorent PoirsonAhmed PasemPhilippe KaroubiVirginie PoupinelCaroline GauthierFrançois BouniolPhilippe FeuchereFlorent BavozetAnne HéronSerge CarreiraMalo EmeryAnne Sophie Le FlochLuana GiovannangeliNicolas HerzogChristophe GiacardiThibaut BaudicChloé ThillSaïd LebbahJessica PalmyreFlorence TubachDavid HajageNicolas BonnetNathan EbsteinStéphane GaudryY. CohenJulie NoublancheOlivier LesieurArnaud SémentIsabel Roca-CerezoMichel PascalNesrine SmaGwenhaël ColinJean-Claude LachéradeGauthier BionzNatacha MaquigneauPierre BouzatM. DurandMarie-Christine HéraultJean‐François Payen
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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.Keywords:
2019-20 coronavirus outbreak
Coronavirus
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Objectives: The aim of the study was to determine the benefit of prone positioning (PP) in patients with acute respiratory failure (ARF) on extracorporeal membrane oxygenation (ECMO) after cardiac surgery.
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A 3-year-old girl with acute respiratory distress syndrome due to a H1N1 2009 influenza virus infection was complicated by necrotizing pneumonia was successfully treated with extracorporeal membrane oxygenation (ECMO). This is the first reported case in which a pediatric patient was rescued with ECMO during the H1N1 influenza epidemic in Korea in 2009.
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Venovenous extracorporeal membrane oxygenation (VV-ECMO) may be a lifesaving rescue therapy for patients with severe coronavirus disease 2019 (COVID-19). However, little is known regarding the efficacy of prolonged ECMO (duration longer than 14 days) in patients with COVID-19. In this case report, we report the successful use of prolonged VV-ECMO (111 days) in a 61-year-old man with severe COVID-19. Given the high mortality rate of severe COVID-19, this case provided evidence for use of prolonged VV-ECMO as supportive care in patients with severe COVID-19.
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Objectives: Extracorporeal membrane oxygenation (ECMO) is a common therapy for patients with severe respiratory failure or cardiogenic shock. Advances in ECMO technology and intensive care medicine led to a more liberal use for ECMO as rescue therapy. We observed a marked increase in ECMO implantations over the last 3 years. Thus, we sought to evaluate the outcome of our ECMO rescue program regarding indication, ECMO-related complications, and survival.
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