The study, led by (clockwise from top) Drs. Eddy Fan, Martin Urner and John Fraser, is the largest international collaboration examining the effectiveness of ECMO in saving lives during the pandemic. (Graphic: UHN StRIDe team)
A new study published in the British medical journalled by researchers from the University Health Network and the COVID-19 Critical Care Consortium (COVID Critical) showed that a life support system for acute respiratory failure called ECMO (extracorporeal membrane oxygenation) was associated with reduced 7.1% COVID mortality when compared to mechanical ventilation alone.
During the pandemic, ECMO has been used around the world as a last resort intervention to save some of the sickest COVID-19 patients. This study is the first to demonstrate that it provides a significant benefit in acute respiratory failure due to COVID-19, in particular for patients under the age of 65 with severely impaired gas exchange or exposure to higher intensities. high levels of mechanical ventilation in the early phase of the disease course.
This was the largest international registry-based cohort study examining the effectiveness of ECMO in treating acute respiratory failure caused by COVID-19. It compared the results of 7,345 adult patients admitted to intensive care units with clinically suspected or laboratory-confirmed cases of COVID-19 in 30 countries.
The study’s lead author is Dr. Eddy Fan, medical director of the Extracorporeal Life Support (ECLS) program at UHN and scientist at the Toronto General Hospital Research Institute. He says this high-impact study was made possible by the global alliance of medical professionals and researchers behind COVID Critical.
“Less than two years ago, the world had no data, no information on the effectiveness of ECMO in treating patients with COVID-related severe acute respiratory failure,” he says.
“With this study, we were able to take millions of data points, use the data to mimic a randomized controlled trial (RCT) and fill that knowledge gap,” says Dr. Fan, who is also an associate professor of medicine at the University of Toronto.
Dr. Martin Urner, first author of the study and clinical researcher and critical care medicine researcher at UHN, said that by using advanced statistical methods to model an RCT, the team was able to quantify the effect of ECMO on the outcomes of adult patients with COVID-19, compared to treatment with mechanical ventilation alone.
“The results provide evidence that ECMO is a highly effective and lifesaving therapy for well-selected patients with catastrophic forms of lung failure due to COVID-19,” Dr. Urner said.
According to COVID Critical co-founder John F. Fraser, Drs. Fan and Urner took “big data” and, working with leading statisticians at COVID Critical, Drs. Adrian Barnett and Nicole White have “cracked the code” to analyze observational data in a revolutionary way, mimicking a randomized controlled trial, which could never be done in a clinical setting.
“The way the data was used is a world first,” says Dr Fraser. “We took the largest known resource of anonymized patient data and interrogated it to shed new light on COVID-19 and the treatment and mortality options associated with ARDS (acute respiratory distress syndrome).”
The COVID-19 Critical Care Consortium consists of more than 400 collaborating centers in 64 countries, contributing data to the world’s largest known database of COVID-19 ICU patient information.
This work was funded in part by donors to the UHN Foundation.