Use of dialysis, tracheostomy, and extracorporeal membrane oxygenation among 240,392 patients hospitalized with COVID-19 in the United States

Burn, Edward; Sena, Anthony G.; Prats-Uribe, Albert; Spotnitz, Matthew; DuVall, Scott; Lynch, Kristine E.; Matheny, Michael E.; Nyberg, Fredrik; Ahmed, Waheed-Ul-Rahman; Alser, Osaid; Alghoul, Heba; Alshammari, Thamir; Zhang, Lin; Casajust, Paula; Areia, Carlos; Shah, Karishma; Reich, Christian; Blacketer, Clair; Andryc, Alan; Fortin, Stephen; Natarajan, Karthik; Gong, Mengchun; Golozar, Asieh; Morales, Daniel; Rijnbeek, Peter; Subbian, Vignesh; Roel, Elena; Recalde, Martina; Lane, Jennifer C.E.; Vizcaya, David; Posada, Jose D.; Shah, Nigam H.; Jonnagaddala, Jitendra; Lai, Lana Yin Hui; Avilés-Jurado, Francesc Xavier; Hripcsak, George; Suchard, Marc A.; Ranzani, Otavio T.; Ryan, Patrick; Prieto-Alhambra, Daniel; Kostka, Kristin; Duarte-Salles, Talita

OBJECTIVE: To estimate the proportion of patients hospitalized with COVID-19 who undergo dialysis, tracheostomy, and extracorporeal membrane oxygenation (ECMO). DESIGN: A network cohort study. SETTING: Six databases from the United States containing routinely-collected patient data: HealthVerity, Premier, IQVIA Open Claims, Optum EHR, Optum SES, and VA-OMOP. PATIENTS: Patients hospitalized with a clinical diagnosis or a positive test result for COVID-19. INTERVENTIONS: Dialysis, tracheostomy, and ECMO. MEASUREMENTS AND MAIN RESULTS: 240,392 patients hospitalized with COVID-19 were included (22,887 from HealthVerity, 139,971 from IQVIA Open Claims, 29,061 from Optum EHR, 4,336 from OPTUM SES, 36,019 from Premier, and 8,118 from VA-OMOP). Across the six databases, 9,703 (4.04% [95% CI: 3.96% to 4.11%]) patients received dialysis, 1,681 (0.70% [0.67% to 0.73%]) had a tracheostomy, and 398 (0.17% [95% CI: 0.15% to 0.18%]) patients underwent ECMO over the 30 days following hospitalization. Use of ECMO was generally concentrated among patients who were younger, male, and with fewer comorbidities except for obesity. Tracheostomy was used for a similar proportion of patients regardless of age, sex, or comorbidity. While dialysis was used for a similar proportion among younger and older patients, it was more frequent among male patients and among those with chronic kidney disease. CONCLUSION: Use of dialysis among those hospitalized with COVID-19 is high at around 4%. Although less than one percent of patients undergo tracheostomy and ECMO, the absolute numbers of patients who have undergone these interventions is substantial and can be expected to continue grow given the continuing spread of the COVID-19.