It has stored lives beyond virus outbreaks that damage the lungs. Now, the survival option known as ECMO turns out to do the same for many critical COVID-19 patients who get it, according to a foreign study through a researcher at the University of Michigan.
The 1035 patients in the study had an incredibly high death threat because fans and other care did not help their lungs. But after undergoing ECMO (oxygenation through an extracorporeal membrane) their actual mortality rate was less than 40%. the rate observed in patients treated with ECMO previous outbreaks of viruses that damage the lungs and other severe bureaucracy of viral pneumonia.
The new study published in The Lancet provides solid information for the use of ECMO in appropriate patients as the pandemic spreads worldwide, possibly helping more ECMO-equipped hospitals realize which of their COVID-19 patients can also benefit from the technique. , which channels blood out of the frame and into a circuit of the apparatus that adds oxygen directly to the blood before returning it to normal circulation.
However, the foreign team of authors warns that patients who exhibit symptoms of need for complex, life-saving care get it in hospitals with experienced ECMO equipment, and that hospitals should not consult to load ECMO functions in the middle of a pandemic.
The test was made imaginable through a rapidly created foreign registry that gave experts extensive near real-time knowledge of the use of ECMO in COVID-19 patients since the beginning of the year.
Hosted through the Extracorporeal Life Support Organization (ELSO), the record includes knowledge sent through the 213 hospitals on 4 continents whose patients were included in the new analysis. May 16 and 1 and follow them to death, discharge or August 5, according to the first eventuality.
”These effects of hospitals experienced in the provision of ECMO are similar to previous reports from ECMO patients, along with another bureaucracy of acute respiratory misery syndrome or viral pneumonia,’ says Michigan Medicine co-author Ryan Barbaro, UM University Medical Center. “These effects help recommendations for ECMO in COVID-19 in case of fan failure. We hope these effects will help hospitals make decisions about this resource-intensive option”
The lead co-author, Graeme MacLaren of the Health System at the National University of Singapore, said most of the centers examined wanted to use ECMO for COVID-19 very often.
“By gathering knowledge from more than two hundred foreign centers in the same study, ELSO deepened our wisdom about using ECMO for COVID-19 in a way that would allow individual centers to be informed for themselves,” he said.
70% of the patients examined were transferred to the hospital where they obtained ECMO; half of them were introduced into ECMO, probably through the host hospital team, prior to their transfer, reinforcing the importance of communication between ECMO-compatible and non-ECMO hospitals that may have COVID-19 patients who can also gain ECMO benefits.
The new test can also identify patients who will get the most out of their ECMO configuration.
“Our effects also show that the death threat increases particularly with the patient’s age, and that those who are immunosuppressed suffer acute kidney damage, ventilation disorders or COVID-19-like cardiac arrests are less likely to survive,” he said. Barbaro, who chairs the ELSO Registration Committee. COVID-19 and provides ECMO care as a pediatric physician for extensive care at um’s CS Mott Children’s Hospital.
“Those who want ECMO to update the center and lung service have also made it worse. All this wisdom can be felt by schools and families what patients might face if placed in ECMO. “
The lead co-author, Daniel Brodie of New York Presbyterian Hospital, said the lack of reliable data at the beginning of the pandemic hindered the study team’s ability to play the role of ECMO in COVID-19.
“The effects of this large-scale, if inconclusive, foreign registration study offer a genuine ECMO perspective to save lives in a highly determined population of COVID-19 patients,” said Brodie, who has the main paternity. with Roberto Lorusso from Maastricht University Medical Centre in the Netherlands and Alain Combes from the Sorbonne University in Paris.
Because the ELSO database does not track what happens to patients once they are sent home, to other hospitals, and to long-term care or rehabilitation facilities, the test used a statistical technique on hospital mortality up to 90 days after the patient’s departure. ECMO. This also allowed the team to report on the 67 patients who were still in the hospital as of August 5, whether they were still in ECMO, the ICU or retirement units.
Philip Boonstra, of the U-M School of Public Health, contributed to the design of the study of a “competitive risk” approach, based on his delight in the design and analysis of long-term statistical knowledge of clinical trials on cancer.
“We use hospital mortality at 90 days because it’s the most threatening era and because it allows us to make the most of the data we have, even if we don’t know the end result for the patient,” he said.
Having knowledge until August, when only a small number of patients on the test remained in the hospital, it was important, although knowledge is lacking in a small number of patients, and while patients who have been sent home or to a rehabilitation center most likely do so. have a prolonged recovery from the extensive care involved in ECMO, most likely based on beyond knowledge. However, the plight of those who have visited long-term care facilities, which provide long-term care at a point close to ICU, is less safe.
More than part of the patients on the test were treated in hospitals in the United States and Canada, adding Michigan Medicine’s own hospitals. Robert Bartlett of the UM, professor emeritus of surgery and co-author of the new article, is a key figure in the progression of ECMO, adding the first use in adults in the 1980s and led the progression of the initial rules for the use of ECMO in COVID-19.
“ECMO is the latest step in the set of rules for managing life-threatening lung failure in complex extensive care units,” Bartlett said. “Now we know it’s effective in COVID-19. “
As of 5 August, 380 of the patients examined had died in the hospital, more than 80% of them within 24 hours of a proactive resolution to discontinue ECMO care due to poor prognosis; of the remaining patients, 57% had returned home. rehabilitation centre (311 patients) or had been sent back to the acute hospital or care center (277 patients). The others were still in the hospital but had turned 90 days after the start of ecMO.
The new review is in addition to the data used to create the ECMO COVID-19 rules published through ELSO, which are part of previous randomized controlled trials on the use of ECMO in SDRA.
Barbaro and others are analyzing the long-term effects of ECMO care on any patient; leads a team that recently won a grant from the National Institutes of Health for a long-term number of young people who survived after ECMO treatment.
Meanwhile, ELSO registration continues to monitor patient care in ECMO due to COVID-19. Christine Stead, Executive Director of ELSO, attributes the immediate turn and intense teamwork between ECMO centers and them by force of the new article.
“We started with a WeChat discussion with groups in China, who were able to express their wisdom and help their Japanese counterparts be in a position to distribute in their country,” he said. “We asked all elSO participating centers to replace the practice and start entering patient knowledge as soon as it was placed at ECMO, rather than waiting for them to be discharged from the hospital, which has enabled us to achieve anything that helps hospitals make more informed decisions, based on meaningful knowledge , as the pandemic continues.