Multi-institutional Analysis of 505 COVID-19 Patients Supported with ECMO: Predictors of Survival

Hall et al., The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2022.01.043, Feb 2022
Mortality 11% improvement lower risk ← → higher risk HCQ for COVID-19  Hall et al.  ICU PATIENTS   Is very late treatment with HCQ beneficial for COVID-19? Retrospective 505 patients in the USA Lower mortality with HCQ (not stat. sig., p=0.31) c19early.org Hall et al., The Annals of Thoracic Su.., Feb 2022 0 0.5 1 1.5 2+ RR
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 424 studies, used in 59 countries.
Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
6,200+ studies for 200+ treatments. c19early.org
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Retrospective 505 ECMO patients showing no significant difference in mortality in unadjusted results.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments. This may explain in part the very high mortality seen in this study. Results may differ in countries with improved SOC.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
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risk of death, 11.2% lower, RR 0.89, p = 0.31, treatment 31 of 56 (55.4%), control 280 of 449 (62.4%), NNT 14.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Hall et al., 18 Feb 2022, retrospective, USA, peer-reviewed, 15 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Multi-institutional Analysis of 505 Patients With Coronavirus Disease-2019 Supported With Extracorporeal Membrane Oxygenation: Predictors of Survival
Celeste A Hall, MD Jeffrey P Jacobs, MSA Alfred H Stammers, James D St. Louis, J W Awori Hayanga, MD Michael S Firstenberg, CCP Linda B Mongero, PhD Eric A Tesdahl, MD Keshava Rajagopal, PhD Faisal H Cheema, CCP Kirti Patel, CCP Tom Coley, CCP Anthony K Sestokas, PhD Marvin J Slepian, MD Vinay Badhwar
The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2022.01.043
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
References
Badulak, Antonini, Stead, Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization, ASAIO J
Barbaro, Maclaren, Boonstra, Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry, Lancet
Bartlett, Ogino, Brodie, Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure, ASAIO J
Basil, Katzen, Engler, The Cellular and Physiological Basis for Lung Repair and Regeneration: Past, Present, and Future, Cell Stem Cell
Clerkin, Fried, Raikhelkar, COVID-19 and Cardiovascular Disease, Circulation
Core, R: A language and environment for statistical computing
Harrell, Dupont, Others, Hmisc': Harrell Miscellaneous. R package version 4
Harrell, rmsb': Bayesian Regression Modeling Strategies
Henry, COVID-19, ECMO, and lymphopenia: a word of caution, Lancet Respir Med
Jacobs, Falasa, Machuca, Commentary: Extracorporeal membrane oxygenation for patients with refractory Coronavirus Disease 2019: What do we know and what do we need to learn?, J Thorac Cardiovasc Surg
Jacobs, Stammers, Louis Etal, Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in Coronavirus Disease 2019: Experience with 32 Patients, ASAIO J
Jacobs, Stammers, Louis, Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time, ASAIO J
Jacobs, Stammers, Louis, Multi-institutional Analysis of 200 COVID-19 Patients treated with ECMO: Outcomes and Trends, Ann Thorac Surg, doi:10.1016/j.athoracsur.2021.06.026
Kon, Smith, Chang, Extracorporeal Membrane Oxygenation Support in Severe COVID-19, Ann Thorac Surg
Kotton, Morrisey, Lung regeneration: mechanisms, applications and emerging stem cell populations, Nat Med
Kumar, Hu, Yamamoto, Distal airway stem cells yield alveoli in vitro and during lung regeneration following H1N1 influenza infection, Cell
Liu, Liu, Cui, Lung regeneration by multipotent stem cells residing at the bronchioalveolar-duct junction, Nat Genet
Loyalka, Cheema, Rao, Rame, Rajagopal, Early Usage of Extracorporeal Membrane Oxygenation in the Absence of Invasive Mechanical Ventilation to Treat COVID-19-related Hypoxemic Respiratory Failure, ASAIO J
Madjid, Safavi-Naeini, Solomon, Vardeny, Potential Effects of Coronaviruses on the Cardiovascular System: A Review, JAMA Cardiol
Rajagopal, Keller, Akkanti, Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO-A "Living Working Document, ASAIO J
Rajagopal, Keller, Akkanti, Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO-a Living Working Document, Circ Heart Fail
Shih, Dimaio, Squiers, Venovenous extracorporeal membrane oxygenation for patients with refractory coronavirus disease 2019 (COVID-19): Multicenter experience of referral hospitals in a large health care system, J Thorac Cardiovasc Surg, doi:10.1016/j.jtcvs.2020.11.073
Shih, Squiers, Dimaio, Outcomes of Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Distress Syndrome Caused by COVID-19 Versus Influenza, Ann Thorac Surg, doi:10.1016/j.athoracsur.2021.05.060
Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Lancet Respir Med
Zimmermann, Bein, Arlt, Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study, Crit Care
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Late treatment
is less effective
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