The study, led by (clockwise from top) Drs. Eddy Fan, Martin Urner and John Fraser, is the largest international collaboration looking into how effective ECMO was in saving lives during the pandemic. (Graphic: UHN StRIDe Team)
A new study published in the British Medical Journal, led by University Health Network researchers 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 a reduction in COVID mortality by 7.1 per cent when compared with 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, particularly for patients aged less than 65 years with severely impaired gas exchange or exposure to higher intensities of mechanical ventilation in the early phase of the disease course.
This was the largest international registry-based cohort study looking into ECMO effectiveness to treat acute respiratory failure caused by COVID-19. It compared outcomes of 7,345 adult patients admitted to intensive care units with clinically suspected or laboratory confirmed case of COVID-19 in 30 countries.
The senior author of the study is Dr. Eddy Fan, Medical Director of the Extracorporeal Life Support Program (ECLS) at UHN and a scientist at the Toronto General Hospital Research Institute. He says this high-impact study was made possible by the global alliance of healthcare professionals and researchers behind COVID Critical.
“Less than two years ago, the world had no data, no information on how effective ECMO was in treating patients with COVID-related severe acute respiratory failure,” he says.
“With this study, we were able to take millions of datapoints, use the data to mimic a randomised controlled trial (RCT) and close this knowledge gap,” says Dr. Fan, who is also an Associate Professor of Medicine at the University of Toronto.
Dr. Martin Urner, the study’s first author, and a clinical and research fellow in Critical Care Medicine at UHN, said by using advanced statistical methods to model a RCT, the team was able to quantify the effect of ECMO on outcomes of adult patients with COVID-19, compared to treatment with mechanical ventilation alone.
“The findings provide evidence that ECMO is a highly effective and lifesaving therapy for well-selected patients with catastrophic forms of lung failure from COVID-19,” said Dr. Urner.
According to COVID Critical Co-Founder John F. Fraser, Drs. Fan and Urner have taken “big data” and, working with COVID Critical’s lead statisticians Drs. Adrian Barnett and Nicole White, have “cracked the code” to analyse observational data in a revolutionary way, mimicking a randomized controlled trial, which could never be done in a clinical setting.
“The way in which the data has been used is a world-first,” says Dr. Fraser. “We’ve taken the largest known resource of de-identified patient data and interrogated it to shed new light on COVID-19 and associated ARDS (Acute Respiratory Distress Syndrome) mortality and treatment options.”
The COVID-19 Critical Care Consortium consists of more than 400 collaborating centres in 64 countries, contributing data to the world’s largest known database of COVID-19 ICU patient information.
This work was supported in part by donors to UHN Foundation.