Observational studyCritical care (London, England)2022
Trends in survival during the pandemic in patients with critical COVID-19 receiving mechanical ventilation with or without ECMO: analysis of the Japanese national registry data.
Observational study in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Extracorporeal membrane oxygenation initiation timing and prognosis: a systematic review and meta-analysis.BMC cardiovascular disorders · 2026Pooled it
- Pre-cannulation ventilation duration and the trajectory of venovenous extracorporeal membrane oxygenation in COVID-19-related acute respiratory distress syndrome: a nationwide competing-risks cohort study.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2026Article
- Impact of prefecture-level intensive care unit congestion on mortality in severe COVID-19 patients: a retrospective observational study in Japan.BMC infectious diseases · 2025Observational
- Characteristics of Bleeding Complications in Patients with Severe COVID-19 Requiring Veno-venous Extracorporeal Membrane Oxygenation in Japan.Thrombosis and haemostasis · 2025Observational
- Article
- Use of machine learning models to predict mechanical ventilation, ECMO, and mortality in COVID-19.Frontiers in artificial intelligence · 2025Article
- Increased national critical care demands were associated with a higher mortality of intubated COVID-19 patients in Japan: a retrospective observational study.Journal of intensive care · 2024Article
- Status of COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation in Japan: Nationwide Database Analysis.Cureus · 2024Article
- Successful Management of Critical Acute Respiratory Distress Syndrome following COVID-19 through Extracorporeal Membrane Oxygenation in a Patient with Concurrent Nephrotic Syndrome Relapse.Internal medicine (Tokyo, Japan) · 2023Article
- Extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome: a narrative review.Journal of intensive care · 2023Review
- Usefulness of the Yokohama Advanced Cardiopulmonary Help Team in patients with acute respiratory distress syndrome.Acute medicine & surgeryArticle
- Multisystem inflammatory syndrome in adults with COVID-19 requiring mechanical ventilation: A retrospective cohort study.Acute medicine & surgeryArticle
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundThe survival rate of patients with critical coronavirus disease-19 (COVID-19) over time is inconsistent in different settings. In Japan, a national database was organized to monitor and share the patient generation across the country in an immediate response to the COVID-19 pandemic. This study aimed to evaluate changes in survival over time and the prognostic factors in critical COVID-19 patients receiving mechanical ventilation with/without extracorporeal membrane oxygenation (ECMO) using the largest database in Japan.
methodsThis is a prospective observational cohort study of patients admitted to intensive care units in Japan with fatal COVID-19 pneumonia receiving mechanical ventilation and/or ECMO. We developed a prospective nationwide registry covering > 80% of intensive care units in Japan, and analyzed the association between patients' backgrounds, institutional ECMO experience, and timing of treatment initiation and prognosis between February 2020 and November 2021. Prognostic factors were evaluated by Kaplan-Meier analysis and Cox proportional hazards analysis.
resultsA total of 9418 patients were ventilated, of whom 1214 (13%) received ECMO. The overall survival rate for ventilated patients was 79%, 65% for those receiving ECMO. There have been five outbreaks in Japan to date. The survival rate of ventilated patients increased from 76% in the first outbreak to 84% in the fifth outbreak (p < 0.001). The survival rate of ECMO patients remained unchanged at 60-68% from the first to fifth outbreaks (p = 0.084). Age of ≥ 59 (hazard ratio [HR] 2.17; 95% confidence interval [CI] 1.76-2.68), ventilator days of ≥ 3 before starting ECMO (HR 1.91; 95% CI 1.57-2.32), and institutional ECMO experiences of ≥ 11 (HR 0.70; 95% CI 0.58-0.85) were independent prognostic factors for ECMO.
conclusionsDuring five COVID-19 outbreaks in Japan, the survival rate of ventilated patients tended to have gradually improved, and that of ECMO patients did not deteriorate. Older age, longer ventilator days before starting ECMO, and fewer institutional ECMO experiences may be independent prognostic factors for critical COVID-19 patients receiving ECMO.
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