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Refractory Hypoxemia Despite Extracorporeal Membrane Oxygenation: Point-of-Care Ultrasound Is Needed for Patients With COVID-19.

ABSTRACT:

SUBMITTER: Rali AS

PROVIDER: S-EPMC8021944 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Refractory Hypoxemia Despite Extracorporeal Membrane Oxygenation: Point-of-Care Ultrasound Is Needed for Patients With COVID-19.

Rali Aniket S AS Taylor Zachary Z George Joggy J Trevino Sergio S Diaz-Gomez Jose L JL

Chest 20210406 4

PMID: 34022034

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Project description:BackgroundAsthma exacerbations with respiratory failure (AERF) are associated with hospital mortality of 7% to 15%. Extracorporeal membrane oxygenation (ECMO) has been used as a salvage therapy for refractory AERF, but controlled studies showing its association with mortality have not been performed.Research questionIs treatment with ECMO associated with lower mortality in refractory AERF compared with standard care?Study design and methodsThis is a retrospective, epidemiologic, observational cohort study using a national, administrative data set from 2010 to 2020 that includes 25% of US hospitalizations. People were included if they were admitted to an ECMO-capable hospital with an asthma exacerbation, and were treated with short-acting bronchodilators, systemic corticosteroids, and invasive ventilation. People were excluded for age < 18 years, no ICU stay, nonasthma chronic lung disease, COVID-19, or multiple admissions. The main exposure was ECMO vs No ECMO. The primary outcome was hospital mortality. Key secondary outcomes were ICU length of stay (LOS), hospital LOS, time receiving invasive ventilation, and total hospital costs.ResultsThe study analyzed 13,714 patients with AERF, including 127 with ECMO and 13,587 with No ECMO. ECMO was associated with reduced mortality in the covariate-adjusted (OR, 0.33; 95% CI, 0.17-0.64; P = .001), propensity score-adjusted (OR, 0.36; 95% CI, 0.16-0.81; P = .01), and propensity score-matched models (OR, 0.48; 95% CI, 0.24-0.98; P = .04) vs No ECMO. Sensitivity analyses showed that mortality reduction related to ECMO ranged from OR 0.34 to 0.61. ECMO was also associated with increased hospital costs in all three models (P < .0001 for all) vs No ECMO, but not with decreased ICU LOS, hospital LOS, or time receiving invasive ventilation.InterpretationECMO was associated with lower mortality and higher hospital costs, suggesting that it may be an important salvage therapy for refractory AERF following confirmatory clinical trials.

Dataset Information

Refractory Hypoxemia Despite Extracorporeal Membrane Oxygenation: Point-of-Care Ultrasound Is Needed for Patients With COVID-19.

Publications

Refractory Hypoxemia Despite Extracorporeal Membrane Oxygenation: Point-of-Care Ultrasound Is Needed for Patients With COVID-19.

Similar Datasets

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