Table 2.
Supportive care and therapies delivered before ECMO
|
Full cohort (n=1035) |
ARDS cohort*(n=779) |
||||
|---|---|---|---|---|---|
| N | Median (IQR) or n (%) | N | Median (IQR) or n (%) | ||
| Non-invasive ventilation | |||||
| Non-invasive ventilation before intubation | 1032 | 606 (59%) | 776 | 434 (56%) | |
| BiPAP | 1032 | 185 (18%) | 776 | 119 (15%) | |
| CPAP | 1032 | 140 (14%) | 776 | 80 (10%) | |
| HFNC | 1032 | 357 (35%) | 776 | 285 (37%) | |
| Pre-ECMO intubation (days) | 914 | 4·0 (1·8–6·4) | 688 | 4·3 (2·0–6·5) | |
| Conventional ventilation† | 951 | 942 (99%) | 729 | 721 (99%) | |
| PEEP (cm H2O) | 868 | 14 (12–16) | 661 | 15 (12–18) | |
| PIP (cm H2O) | 699 | 33 (30–38) | 532 | 34 (30–38) | |
| FiO2 | 888 | 1·0 (0·90–1·0) | 672 | 1·0 (0·90–1·0) | |
| PaO2:FiO2 (mm Hg) | 868 | 72 (59–94) | 657 | 72 (60–93) | |
| PaCO2 (mm Hg) | 896 | 60 (50–74) | 678 | 60 (50–74) | |
| Pre-ECMO support | |||||
| Prone positioning | 1019 | 612 (60%) | 766 | 464 (61%) | |
| Neuromuscular blockade | 1015 | 729 (72%) | 762 | 567 (74%) | |
| Inhaled pulmonary vasodilators | 1019 | 293 (29%) | 766 | 242 (32%) | |
| Any vasoactive support | 1015 | 606 (60%) | 758 | 447 (59%) | |
| Norepinephrine | 1015 | 561 (55%) | 762 | 416 (55%) | |
| COVID-19 therapies and immunomodulators | |||||
| Any therapy | 1035 | 786 (76%) | 779 | 633 (81%) | |
| Glucocorticoids | 1035 | 420 (41%) | 779 | 331 (42%) | |
| Intravenous immunoglobin | 1035 | 29 (3%) | 779 | 22 (3%) | |
| Anticytokine | 1035 | 289 (28%) | 779 | 261 (34%) | |
| Lopinavir–ritonavir | 1035 | 116 (11%) | 779 | 103 (13%) | |
| JAK inhibition | 1035 | 7 (0·7%) | 779 | 5 (0·6%) | |
| Chloroquine or hydroxychloroquine | 1035 | 538 (52%) | 779 | 443 (57%) | |
| Remdesivir | 1035 | 84 (8%) | 779 | 69 (9%) | |
| Support type | |||||
| Respiratory | 1035 | 995 (96%) | 779 | 777 (99·7%) | |
| Cardiac | 1035 | 29 (3%) | 779 | 0 | |
| ECPR | 1035 | 11 (1%) | 779 | 2 (0·3%) | |
ARDS=acute respiratory distress syndrome. BiPAP=bilevel positive airway pressure. CPAP=continuous positive airway pressure. ECMO=extracorporeal membrane oxygenation. ECPR=extracorporeal cardiopulmonary resuscitation. FiO2=fraction of inspired oxygen. HFNC=high flow nasal cannula. JAK=Janus kinase. PaCO2=partial pressure of arterial carbon dioxide. PaO2:FiO2=ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen. PEEP=positive end-expiratory pressure. PIP=peak inspiratory pressure.
The ARDS cohort were the subset of ECMO-supported patients with COVID-19 who met the following two criteria: (1) classified by the Extracorporeal Life Support Organization data manager as having ARDS, and (2) initial mode of ECMO support was venovenous ECMO.
Mode of mechanical ventilation, the PEEP, PIP, FiO2, PaO2:FiO2, and PaCO2are measured within 6 h before ECMO initiation and are the measure nearest to ECMO initiation while still remaining pre-ECMO initiation.