Extracorporeal Membrane Oxygenation for COVID-19 During the Delta and Omicron Waves in North America.

IF 3.1 3区医学 Q2 ENGINEERING, BIOMEDICAL ASAIO Journal Pub Date : 2024-10-23 DOI:10.1097/MAT.0000000000002334

Andrew J Hickey, Richard Greendyk, Matthew J Cummings, Darryl Abrams, Max R O'Donnell, Craig R Rackley, Ryan P Barbaro, Daniel Brodie, Cara Agerstrand

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Abstract

Clinical outcomes for patients with severe acute respiratory failure caused by different variants of the coronavirus disease 2019 (COVID-19) supported with extracorporeal membrane oxygenation (ECMO) are incompletely understood. Clinical characteristics, pre-ECMO management, and hospital mortality at 90 days for adults with COVID-19 who received venovenous ECMO (VV-ECMO) at North American centers during waves predominated by Delta (August 16 to December 12, 2021) and Omicron (January 31 to May 31, 2022) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants were compared in a competing risks framework. One thousand seven hundred and sixty-six patients (1,580 Delta, 186 Omicron) received VV-ECMO for COVID-19 during the Delta- and Omicron-predominant waves in North American centers. In the unadjusted competing risks model, no significant difference was observed in risk of hospital mortality at 90 days between patients during the Delta- versus Omicron-predominant wave (subhazard ratio [sHR], 0.94; 95% confidence interval [CI], 0.74-1.19), but patients supported with VV-ECMO during the Omicron-predominant wave had a significantly lower adjusted risk of hospital mortality at 90 days (subhazard ratio, 0.71; 95% CI, 0.51-0.99). Patients receiving VV-ECMO during the Omicron-predominant wave had a similar unadjusted risk of hospital mortality at 90 days, but a significantly lower adjusted risk of hospital mortality at 90 days than those receiving VV-ECMO during the Delta-predominant wave.

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北美德尔塔波和欧米茄波期间为 COVID-19 进行体外膜氧合。

人们对冠状病毒病 2019（COVID-19）不同变种引起的严重急性呼吸衰竭患者在体外膜肺氧合（ECMO）支持下的临床疗效尚不完全了解。我们在竞争风险框架下比较了在以Delta（2021年8月16日至12月12日）和Omicron（2022年1月31日至5月31日）严重急性呼吸系统综合征冠状病毒2（SARS-CoV-2）变种为主的波次中，在北美中心接受静脉ECMO（VV-ECMO）治疗的COVID-19成人患者的临床特征、ECMO前管理和90天时的住院死亡率。在北美中心的德尔塔波和奥米克隆波主导期间，有 1766 名患者（1580 名德尔塔波患者和 186 名奥米克隆波患者）接受了针对 COVID-19 的 VV-ECMO 治疗。在未经调整的竞争风险模型中，Delta 波和 Omicron 波患者的 90 天住院死亡风险无明显差异（亚危险比 [sHR]，0.94；95% 置信区间 [CI]，0.74-1.19），但在 Omicron 波接受 VV-ECMO 治疗的患者 90 天住院死亡风险经调整后显著降低（亚危险比，0.71；95% 置信区间，0.51-0.99）。在奥米克龙主导波期间接受VV-ECMO治疗的患者90天时的未调整住院死亡风险与在德尔塔主导波期间接受VV-ECMO治疗的患者相似，但90天时的调整住院死亡风险明显低于在德尔塔主导波期间接受VV-ECMO治疗的患者。

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来源期刊

ASAIO Journal 医学-工程：生物医学

CiteScore

6.60

自引率

7.10%

发文量

651

审稿时长

4-8 weeks

期刊介绍： ASAIO Journal is in the forefront of artificial organ research and development. On the cutting edge of innovative technology, it features peer-reviewed articles of the highest quality that describe research, development, the most recent advances in the design of artificial organ devices and findings from initial testing. Bimonthly, the ASAIO Journal features state-of-the-art investigations, laboratory and clinical trials, and discussions and opinions from experts around the world. The official publication of the American Society for Artificial Internal Organs.