Open AccessExtracorporeal Membrane Oxygenation for COVID-19–associated Severe Acute Respiratory Distress Syndrome in Chile: A Nationwide Incidence and Cohort Study
Author(s) -
Rodrigo Díaz,
Jerónimo Graf,
José M Zambrano,
Carolina Ruíz,
Juan A Espinoza,
Sebastián Bravo,
Pablo A Salazar,
Juan Carlos Bahamondes,
Luis Castillo,
Abraham Gajardo,
Andrés Kursbaum,
Leonila Ferreira,
Josefa Valenzuela,
Roberto Castillo,
Rodrigo PérezAraos,
Marcela Bravo,
Andrés Aquevedo,
Mauricio González,
Rodrigo Otavio Lami Pereira,
Leandro Ortega,
César Santis,
P Fernández,
Vilma Ortiz Cortes,
Rodrigo Cornejo
Publication year - 2021
Publication title -
american journal of respiratory and critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.272
H-Index - 374
eISSN - 1535-4970
pISSN - 1073-449X
DOI - 10.1164/rccm.202011-4166oc
Subject(s) - medicine , interquartile range , extracorporeal membrane oxygenation , population , cumulative incidence , retrospective cohort study , ards , cohort , incidence (geometry) , cohort study , pediatrics , lung , physics , environmental health , optics
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 Pa O 2 /Fi O 2 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.