Characteristics and Outcomes of COVID-19 Patients Supported by Venoarterial or Veno-Arterial-Venous Extracorporeal Membrane Oxygenation

Haroun, Magued; Patel, Snehal R.; Sims, Daniel B.; Jorde, Ulrich P.; Goldstein, Daniel J.; Saeed, Omar

doi:10.1053/j.jvca.2022.01.049

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…Data about survival of COVID-19 patients on VA-ECMO is limited [ 10 ]. Only few studies report survival rates of patients on VA-ECMO due to COVID-19 ranging from 27.9% to 36% [ 4 , 5 , 11 ]. In our study, overall survival was 39% which is line with the available data, especially data from the EuroELSO registry [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thousands of patients needed veno-venous extracorporeal membrane oxygenation (VV-ECMO) [ 3 ], the mortality varied, ranging from 23% to 73%. Besides pulmonary support, circulatory support by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was necessary in COVID-19 patients [ 4 ] with high mortality rates up to 72% [ 5 ]. Common indications for circulatory support by VA-ECMO are pulmonary embolism (PE) or circulatory failure due to myocardial infarction or myocarditis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Wiest,

Philipp,

Foltan

et al. 2024

PLoS ONE

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Objective In this retrospective case series, survival rates in different indications for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and differential diagnoses of COVID-19 associated refractory circulatory failure are investigated. Methods Retrospective analysis of 28 consecutive COVID-19 patients requiring VA-ECMO. All VA-ECMO’s were cannulated peripherally, using a femoro-femoral cannulation. Results At VA-ECMO initiation, median age was 57 years (IQR: 51–62), SOFA score 16 (IQR: 13–17) and norepinephrine dosing 0.53μg/kg/min (IQR: 0.35–0.87). Virus-variants were: 61% wild-type, 14% Alpha, 18% Delta and 7% Omicron. Indications for VA-ECMO support were pulmonary embolism (PE) (n = 5, survival 80%), right heart failure due to secondary pulmonary hypertension (n = 5, survival 20%), cardiac arrest (n = 4, survival 25%), acute heart failure (AHF) (n = 10, survival 40%) and refractory vasoplegia (n = 4, survival 0%). Among the patients with AHF, 4 patients suffered from COVID-19 associated heart failure (CovHF) (survival 100%) and 6 patients from sepsis associated heart failure (SHF) (survival 0%). Main Complications were acute kidney injury (AKI) 93%, renal replacement therapy was needed in 79%, intracranial hemorrhage occurred in 18%. Overall survival to hospital discharge was 39%. Conclusion Survival on VA-ECMO in COVID-19 depends on VA-ECMO indication, which should be considered in further studies and clinical decision making. A subgroup of patients suffers from acute heart failure due to inflammation, which has to be differentiated into septic or COVID-19 associated. Novel biomarkers are required to ensure reliable differentiation between these entities; a candidate might be soluble interleukin 2 receptor.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Wiest,

Philipp,

Foltan

et al. 2024

PLoS ONE

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“…Of these articles, seventeen cohorts reported the time from symptom onset to ECMO [22,24,26,31,39,40,42,44,50,[54][55][56]61,63,65,67,70], four reported the time from COVID-19 diagnosis to ECMO [34,38,47,52], eleven reported the time from hospital admission to ECMO [20,24,25,39,42,46,48,61,64,66,71], four reported time from ICU admission to ECMO [23,29,44,61], thirty-nine reported time from intubation or MV to ECMO [19,24,[26][27][28][29][30][33][34][35][36][37][38]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Of the total articles, twentyfour studies were conducted in the Americas (twenty-two in the United States of America (USA) [19][20][21]24,25,32,34,35,38,39,46,47,52,54,55,57,58,61,65,66,68,70], one in Argentina [26], one in Chile [29]), twenty-three in Europe (nine in France [22,29,33,42,44,49,50,59,60], six in Germany [31,37,41,48,62,71], two in the United Kingdom of Great Britain and Northern Ireland (UK) [27,72], two in Spain [51,56], one in Finland [23], one in Austria [36], one in Poland [64], one in Italy [45]), seven in Asia (three in China [28,…”

Section: Study Characteristicsmentioning

confidence: 99%

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

Tan,

Su,

Chen

et al. 2024

JCM

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Background: Coronavirus disease 2019 (COVID-19) is the etiology of acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used to support gas exchange in patients who have failed conventional mechanical ventilation. However, there is no clear consensus on the timing of ECMO use in severe COVID-19 patients. Objective: The aim of this study is to compare the differences in pre-ECMO time and ECMO duration between COVID-19 survivors and non-survivors and to explore the association between them. Methods: PubMed, the Cochrane Library, Embase, and other sources were searched until 21 October 2022. Studies reporting the relationship between ECMO-related time and COVID-19 survival were included. All available data were pooled using random-effects methods. Linear regression analysis was used to determine the correlation between pre-ECMO time and ECMO duration. The meta-analysis was registered with PROSPERO under registration number CRD42023403236. Results: Out of the initial 2473 citations, we analyzed 318 full-text articles, and 54 studies were included, involving 13,691 patients. There were significant differences between survivors and non-survivors in the time from COVID-19 diagnosis (standardized mean difference (SMD) = −0.41, 95% confidence interval (CI): [−0.53, −0.29], p < 0.00001), hospital (SMD = −0.53, 95% CI: [−0.97, −0.09], p = 0.02) and intensive care unit (ICU) admission (SMD = −0.28, 95% CI: [−0.49, −0.08], p = 0.007), intubation or mechanical ventilation to ECMO (SMD = −0.21, 95% CI: [−0.32, −0.09], p = 0.0003) and ECMO duration (SMD = −0.18, 95% CI: [−0.30, −0.06], p = 0.003). There was no statistical association between a longer time from symptom onset to ECMO (hazard ratio (HR) = 1.05, 95% CI: [0.99, 1.12], p = 0.11) or time from intubation or mechanical ventilation (MV) and the risk of mortality (highest vs. lowest time groups odds ratio (OR) = 1.18, 95% CI: [0.78, 1.78], p = 0.42; per one-day increase OR = 1.14, 95% CI: [0.86, 1.52], p = 0.36; HR = 0.99, 95% CI: [0.95, 1.02], p = 0.39). There was no linear relationship between pre-ECMO time and ECMO duration. Conclusion: There are differences in pre-ECMO time between COVID-19 survivors and non-survivors, and there is insufficient evidence to conclude that longer pre-ECMO time is responsible for reduced survival in COVID-19 patients. ECMO duration differed between survivors and non-survivors, and the timing of pre-ECMO does not have an impact on ECMO duration. Further studies are needed to explore the association between pre-ECMO and ECMO time in the survival of COVID-19 patients.

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“…COVID-19-associated myocarditis has been described several times and repeatedly led to fulminant biventricular failure [ 7 , 8 ]. Cardiorespiratory assist devices such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are frequently used in patients with cardiac failure under COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

Severe COVID-19-associated myocarditis with cardiogenic shock – management with assist devices – a case report & review

et al. 2022

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Background Primary viral myocarditis associated with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection is a rare diagnosis. Case presentation We report the case of an unvaccinated, healthy patient with cardiogenic shock in the context of a COVID-19-associated myocarditis and therapy with simultaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous left ventricular decompression therapy with an Impella. The aim of this review is to provide an overview of therapeutic options for patients with COVID-19-associated myocarditis. Conclusions The majority of patients required a combination of two assist devices to achieve sufficient cardiac output until recovery of left ventricular ejection fraction. Due to the rapid onset of this fulminant cardiogenic shock immediate invasive bridging therapy in a specialized center was lifesaving.

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Characteristics and Outcomes of COVID-19 Patients Supported by Venoarterial or Veno-Arterial-Venous Extracorporeal Membrane Oxygenation

Cited by 7 publications

References 21 publications

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

Severe COVID-19-associated myocarditis with cardiogenic shock – management with assist devices – a case report & review

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