Comparative outcomes of extracorporeal membrane oxygenation for COVID-19 delivered in experienced European centres during successive SARS-CoV-2 variant outbreaks (ECMO-SURGES): an international, multicentre, retrospective cohort study

Schmidt, Matthieu; Hajage, David; Landoll, Micha; Péquignot, Benjamin; Langouet, Elise; Mekontso-Dessap, Armand; Chiscano-Camón, Luis; Surman, Katy; Finnerty, Dylan; Santa-Teresa, Patricia; Millán, Pablo; Roncon‐Albuquerque, Roberto; Blandino-Ortiz, Aaron; Blanco-Schweizer, Pablo; Ricart, Pilar; Gimeno-Costa, Ricardo; Albacete, Carlos; Fortuna, Philip; Schellongowski, Peter; Dauwe, Dieter; Winiszewski, Hadrien; Kimmoun, Antoine; Lévy, Bruno; Hermans, Greet; Grasselli, Giacomo; Lebreton, Guillaume; Guervilly, Christophe; Martucci, Genarro; Karagiannidis, Christian; Riera, Jordi

doi:10.1016/s2213-2600(22)00438-6

Cited by 23 publications

(15 citation statements)

References 35 publications

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“…Age and lactate are clearly related to mortality when VV-ECMO is initiated as in the majority of critically ill patients who present any kind of organ dysfunction (21,24). In fact, both age and lactate are included in the majority of the risk-assessment severity scores used for any kind of ECMO support (25,26).…”

Section: Multivariable Analysis (Tablementioning

confidence: 99%

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Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Fuset-Cabanes

Hernández-Platero

Sabater-Riera

et al. 2023

Preprint

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Background: The study evaluates the impact of the time between commencing non-invasive ventilation (NIV) support and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). Methods: Prospective observational study design in an intensive Care Unit (ICU) of a tertiary hospital in Barcelona (Spain). All patients requiring VV-ECMO support due to COVID-19 associated ARDS between March 2020 and January 2022 were analysed. Survival outcome was determined at 90 days after VV-ECMO initiation. Demographic data, comorbidities at ICU admission, RESP (respiratory ECMO survival prediction) score, antiviral and immunomodulatory treatments received, inflammatory biomarkers, the need for vasopressors, the thromboprophylaxis regimen received, and respiratory parameters including the length of intubation previous to ECMO and the length of each NIV support (high-flow nasal cannula, continuous positive airway pressure and bi-level positive airway pressure), were also collated in order to assess risk factors for day-90 mortality. The effect of the time lapse between NIV support and VV-ECMO on survival was evaluated using logistic regression and adjusting the association with all factors that were significant in the univariate analysis. Results: Seventy-two patients finally received VV-ECMO support. At 90 days after commencing VV-ECMO 35 (48%) had died and 37 (52%) were alive. Multivariable analysis showed that at VV-ECMO initiation, age (p=0.02), lactate (p=0.001), and days from initiation of NIV support to starting VV-ECMO (p=0.04) were all associated with day-90 mortality. Conclusions: In our small cohort of VV-ECMO patients with COVID-19 associated ARDS, the time spent between initiation of NIV support and VV-ECMO (together with age and lactate) appear to be a better predictor of mortality than that between intubation and VV-ECMO.

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Section: Multivariable Analysis (Tablementioning

confidence: 99%

“…A recent large multicenter study showed an increased mortality in ECMO patients with COVID-19 associated ARDS who had received NIV previous to intubation(21) Many of the patients who received…”

mentioning

confidence: 99%

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Fuset-Cabanes

Hernández-Platero

Sabater-Riera

et al. 2023

Preprint

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“…In conclusion, we welcome the valuable results of the studies by Lorusso and colleagues 4 and Schmidt and colleagues, 5 but we are still limited in our ability to effectively identify candidates for VV-ECMO and to provide patients, families, and other members of the health-care team with a precise expectation of what surviving VV-ECMO entails. We do not yet have a comprehensive understanding of the physical, cognitive, and psychological sequelae of critical illness and ECMO support, or the impact on caregivers.…”

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confidence: 99%

“… 1 , 2 Evolving outcomes of patients on VV-ECMO during the COVID-19 pandemic showed that current selection criteria might not effectively guide decision making under unprecedented levels of health-care system strain, and accentuated the need for reliable prognostic models and better understanding of both short-term and long-term outcomes. 3 In this context, we read with interest the two studies by Roberto Lorusso and colleagues 4 and by Matthieu Schmidt and colleagues, 5 published in The Lancet Respiratory Medicine .…”

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confidence: 99%

“…Schmidt and colleagues 5 did a retrospective, multicentre observational cohort study to describe patient characteristics and outcome at 90 days after the initiation of ECMO in patients with COVID-19, and to identify independent risk factors for mortality according to different SARS-CoV-2 variants during the first 2 years of the COVID-19 pandemic (Jan 1, 2020–Sept 30, 2021). Data from 1345 patients were analysed using multivariable Cox regression models.…”

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confidence: 99%

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VV-ECMO in severe COVID-19: multidimensional perspectives on the use of a complex treatment

Teijeiro-Paradis¹,

Sorbo²

2023

The Lancet Respiratory Medicine

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Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS

Schmidt,

Hajage,

Lebreton

et al. 2023

JAMA

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ImportanceProne positioning may improve outcomes in patients with severe acute respiratory distress syndrome (ARDS), but it is unknown whether prone positioning improves clinical outcomes among patients with ARDS who are undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO) compared with supine positioning.ObjectiveTo test whether prone positioning vs supine positioning decreases the time to successful ECMO weaning in patients with severe ARDS supported by VV-ECMO.Design, Setting, and ParticipantsRandomized clinical trial of patients with severe ARDS undergoing VV-ECMO for less than 48 hours at 14 intensive care units (ICUs) in France between March 3, 2021, and December 7, 2021.InterventionsPatients were randomized 1:1 to prone positioning (at least 4 sessions of 16 hours) (n = 86) or to supine positioning (n = 84).Main Outcomes and MeasuresThe primary outcome was time to successful ECMO weaning within 60 days following randomization. Secondary outcomes included ECMO and mechanical ventilation–free days, ICU and hospital length of stay, skin pressure injury, serious adverse events, and all-cause mortality at 90-day follow-up.ResultsAmong 170 randomized patients (median age, 51 [IQR, 43-59] years; n = 60 women [35%]), median respiratory system compliance was 15.0 (IQR, 10.7-20.6) mL/cm H2O; 159 patients (94%) had COVID-19–related ARDS; and 164 (96%) were in prone position before ECMO initiation. Within 60 days of enrollment, 38 of 86 patients (44%) had successful ECMO weaning in the prone ECMO group compared with 37 of 84 (44%) in the supine ECMO group (risk difference, 0.1% [95% CI, −14.9% to 15.2%]; subdistribution hazard ratio, 1.11 [95% CI, 0.71-1.75]; P = .64). Within 90 days, no significant difference was observed in ECMO duration (28 vs 32 days; difference, −4.9 [95% CI, −11.2 to 1.5] days; P = .13), ICU length of stay, or 90-day mortality (51% vs 48%; risk difference, 2.4% [95% CI, −13.9% to 18.6%]; P = .62). No serious adverse events were reported during the prone position procedure.Conclusions and RelevanceAmong patients with severe ARDS supported by VV-ECMO, prone positioning compared with supine positioning did not significantly reduce time to successful weaning of ECMO.Trial RegistrationClinicalTrials.gov Identifier: NCT04607551

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Comparative outcomes of extracorporeal membrane oxygenation for COVID-19 delivered in experienced European centres during successive SARS-CoV-2 variant outbreaks (ECMO-SURGES): an international, multicentre, retrospective cohort study

Cited by 23 publications

References 35 publications

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

Days spent on non-invasive ventilation support: Can it determine when to initiate VV-ECMO? Observational study in a cohort of Covid-19 patients.

VV-ECMO in severe COVID-19: multidimensional perspectives on the use of a complex treatment

Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS

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