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

Research output: Contribution to journalArticle

454 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1659-1668
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume306
Issue number15
DOIs
StatePublished - Oct 19 2011
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Human Influenza
Referral and Consultation
Mortality
Adult Respiratory Distress Syndrome
Propensity Score
Hospital Mortality
Membranes
Pandemics
Cohort Studies
Severe Acute Respiratory Syndrome

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). / Noah, Moronke A.; Peek, Giles J.; Finney, Simon J.; Griffiths, Mark J.; Harrison, David A.; Grieve, Richard; Sadique, M. Zia; Sekhon, Jasjeet S.; McAuley, Daniel F.; Firmin, Richard K.; Harvey, Christopher; Cordingley, Jeremy J.; Price, Susanna; Vuylsteke, Alain; Jenkins, David P.; Noble, David W.; Bloomfield, Roxanna; Walsh, Timothy S.; Perkins, Gavin D.; Menon, David; Taylor, Bruce L.; Rowan, Kathryn M.

In: JAMA - Journal of the American Medical Association, Vol. 306, No. 15, 19.10.2011, p. 1659-1668.

Research output: Contribution to journalArticle

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)', JAMA - Journal of the American Medical Association, vol. 306, no. 15, pp. 1659-1668. https://doi.org/10.1001/jama.2011.1471
Noah, Moronke A. ; Peek, Giles J. ; Finney, Simon J. ; Griffiths, Mark J. ; Harrison, David A. ; Grieve, Richard ; Sadique, M. Zia ; Sekhon, Jasjeet S. ; McAuley, Daniel F. ; Firmin, Richard K. ; Harvey, Christopher ; Cordingley, Jeremy J. ; Price, Susanna ; Vuylsteke, Alain ; Jenkins, David P. ; Noble, David W. ; Bloomfield, Roxanna ; Walsh, Timothy S. ; Perkins, Gavin D. ; Menon, David ; Taylor, Bruce L. ; Rowan, Kathryn M. / Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). In: JAMA - Journal of the American Medical Association. 2011 ; Vol. 306, No. 15. pp. 1659-1668.
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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.",
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.}",
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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.

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.

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