Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

Moronke A. Noah; Giles J. Peek; Simon J. Finney; Mark J. Griffiths; David A. Harrison; Richard Grieve; M. Zia Sadique; Jasjeet S. Sekhon; Daniel F. McAuley; Richard K. Firmin; Christopher Harvey; Jeremy J. Cordingley; Susanna Price; Alain Vuylsteke; David P. Jenkins; David W. Noble; Roxanna Bloomfield; Timothy S. Walsh; Gavin D. Perkins; David Menon; Bruce L. Taylor; Kathryn M. Rowan

doi:10.1001/jama.2011.1471

Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

Moronke A. Noah, Giles J. Peek^*, Simon J. Finney, Mark J. Griffiths, David A. Harrison, Richard Grieve, M. Zia Sadique, Jasjeet S. Sekhon, Daniel F. McAuley, Richard K. Firmin, Christopher Harvey, Jeremy J. Cordingley, Susanna Price, Alain Vuylsteke, David P. Jenkins, David W. Noble, Roxanna Bloomfield, Timothy S. Walsh, Gavin D. Perkins, David MenonBruce L. Taylor, Kathryn M. Rowan

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Context Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic.

Objective To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO.

Design, Setting, and Patients A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching).

Main Outcome Measure Survival to hospital discharge analyzed according to the intention-to-treat principle.

Results Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P=.006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P=.008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P=.001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated.

Conclusion For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients. JAMA. 2011;306(15):1659-1668 Published online October 5, 2011. doi:10.1001/jama.2011.1471 www.jama.com

Original language	English
Pages (from-to)	1659-1668
Number of pages	10
Journal	Journal of the American Medical Association
Volume	306
Issue number	15
DOIs	https://doi.org/10.1001/jama.2011.1471
Publication status	Published - 19 Oct 2011

Keywords

ACUTE LUNG INJURY
SUFFICIENT EVIDENCE
MECHANICAL VENTILATION
RESPIRATORY-DISTRESS-SYNDROME
CRITICAL-CARE SERVICES
CRITICALLY-ILL PATIENTS
RANDOMIZED CONTROLLED-TRIAL
UNITED-STATES
FAILURE
H1N1 INFLUENZA

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10.1001/jama.2011.1471

PhD STUDENT - JOANNE SIMPSON - Supervisor MOHINI GRAY
Iredale, J.
MRC
1/09/12 → 31/08/16
Project: Research

Cite this

Noah, M. A., Peek, G. J., Finney, S. J., Griffiths, M. J., Harrison, D. A., Grieve, R., Sadique, M. Z., Sekhon, J. S., McAuley, D. F., Firmin, R. K., Harvey, C., Cordingley, J. J., Price, S., Vuylsteke, A., Jenkins, D. P., Noble, D. W., Bloomfield, R., Walsh, T. S., Perkins, G. D., ... Rowan, K. M. (2011). Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1). Journal of the American Medical Association, 306(15), 1659-1668. https://doi.org/10.1001/jama.2011.1471

@article{cb4df993d17f4af6aced3bdb49f860fa,

title = "Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)",

abstract = "Context Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic.Objective To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO.Design, Setting, and Patients A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching).Main Outcome Measure Survival to hospital discharge analyzed according to the intention-to-treat principle.Results Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P=.006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P=.008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P=.001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated.Conclusion For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients. JAMA. 2011;306(15):1659-1668 Published online October 5, 2011. doi:10.1001/jama.2011.1471 www.jama.com",

keywords = "ACUTE LUNG INJURY, SUFFICIENT EVIDENCE, MECHANICAL VENTILATION, RESPIRATORY-DISTRESS-SYNDROME, CRITICAL-CARE SERVICES, CRITICALLY-ILL PATIENTS, RANDOMIZED CONTROLLED-TRIAL, UNITED-STATES, FAILURE, H1N1 INFLUENZA",

author = "Noah, {Moronke A.} and Peek, {Giles J.} and Finney, {Simon J.} and Griffiths, {Mark J.} and Harrison, {David A.} and Richard Grieve and Sadique, {M. Zia} and Sekhon, {Jasjeet S.} and McAuley, {Daniel F.} and Firmin, {Richard K.} and Christopher Harvey and Cordingley, {Jeremy J.} and Susanna Price and Alain Vuylsteke and Jenkins, {David P.} and Noble, {David W.} and Roxanna Bloomfield and Walsh, {Timothy S.} and Perkins, {Gavin D.} and David Menon and Taylor, {Bruce L.} and Rowan, {Kathryn M.}",

year = "2011",

month = oct,

day = "19",

doi = "10.1001/jama.2011.1471",

language = "English",

volume = "306",

pages = "1659--1668",

journal = "Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

number = "15",

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Noah, MA, Peek, GJ, Finney, SJ, Griffiths, MJ, Harrison, DA, Grieve, R, Sadique, MZ, Sekhon, JS, McAuley, DF, Firmin, RK, Harvey, C, Cordingley, JJ, Price, S, Vuylsteke, A, Jenkins, DP, Noble, DW, Bloomfield, R, Walsh, TS, Perkins, GD, Menon, D, Taylor, BL & Rowan, KM 2011, 'Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)', Journal of the American Medical Association, vol. 306, no. 15, pp. 1659-1668. https://doi.org/10.1001/jama.2011.1471

TY - JOUR

T1 - Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

AU - Noah, Moronke A.

AU - Peek, Giles J.

AU - Finney, Simon J.

AU - Griffiths, Mark J.

AU - Harrison, David A.

AU - Grieve, Richard

AU - Sadique, M. Zia

AU - Sekhon, Jasjeet S.

AU - McAuley, Daniel F.

AU - Firmin, Richard K.

AU - Harvey, Christopher

AU - Cordingley, Jeremy J.

AU - Price, Susanna

AU - Vuylsteke, Alain

AU - Jenkins, David P.

AU - Noble, David W.

AU - Bloomfield, Roxanna

AU - Walsh, Timothy S.

AU - Perkins, Gavin D.

AU - Menon, David

AU - Taylor, Bruce L.

AU - Rowan, Kathryn M.

PY - 2011/10/19

Y1 - 2011/10/19

N2 - Context Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic.Objective To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO.Design, Setting, and Patients A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching).Main Outcome Measure Survival to hospital discharge analyzed according to the intention-to-treat principle.Results Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P=.006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P=.008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P=.001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated.Conclusion For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients. JAMA. 2011;306(15):1659-1668 Published online October 5, 2011. doi:10.1001/jama.2011.1471 www.jama.com

AB - Context Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic.Objective To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO.Design, Setting, and Patients A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching).Main Outcome Measure Survival to hospital discharge analyzed according to the intention-to-treat principle.Results Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P=.006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P=.008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P=.001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated.Conclusion For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients. JAMA. 2011;306(15):1659-1668 Published online October 5, 2011. doi:10.1001/jama.2011.1471 www.jama.com

KW - ACUTE LUNG INJURY

KW - SUFFICIENT EVIDENCE

KW - MECHANICAL VENTILATION

KW - RESPIRATORY-DISTRESS-SYNDROME

KW - CRITICAL-CARE SERVICES

KW - CRITICALLY-ILL PATIENTS

KW - RANDOMIZED CONTROLLED-TRIAL

KW - UNITED-STATES

KW - FAILURE

KW - H1N1 INFLUENZA

U2 - 10.1001/jama.2011.1471

DO - 10.1001/jama.2011.1471

M3 - Article

VL - 306

SP - 1659

EP - 1668

JO - Journal of the American Medical Association

JF - Journal of the American Medical Association

SN - 0098-7484

IS - 15

ER -

Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)

Abstract

Keywords

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PhD STUDENT - JOANNE SIMPSON - Supervisor MOHINI GRAY

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