Determinants of survival in patients on extracorporeal membrane oxygenation therapy due to severe covid-19

Abstract

Background Severe acute respiratory distress syndrome (ARDS) due to Coronavirus Disease-19 (COVID-19) is associated with high mortality. Although survival on mechanical circulatory support has improved, determinants for better prognosis are still unclear. Here, we report on the outcome of our patient population with the need for mechanical circulatory support due to severe COVID-19 (sCOVID-19) induced ARDS. Methods All patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS due to sCOVID-19 were analysed. Patients > 18 years of age at the time of initiation of ECMO were included. Pre-existing comorbidities, complications during ECMO implantation, and ECMO runtime were reviewed. The latency to intubation, proning, tracheotomy, and ECMO implantation was analysed. Furthermore, the survival and non-survival population were compared to determine factors in favour of a better outcome. Results In total, 85 patients were treated with veno-venous membrane oxygenation (vv-ECMO) for severe ARDS in our medical centre. The patient population was predominantly male (83.5%) with a mean patient age of 54.9 years. A history of cardiovascular disease ( p = .01), smoking ( p < .05), need for vasopressor- ( p < .05), and renal replacement therapy ( p < .001) was associated with a worse prognosis. Overall survival was 50%. The survival population was significantly younger ( p = .004), had a significantly higher body weight ( p = .02) and body mass index (BMI) ( p = .01). Furthermore, survival was significantly better when vv-ECMO was initiated within 48 h after admission ( p < .001). Conclusions Pre-existing cardiovascular disease, higher age, history of nicotine abuse, and development of renal failure are associated with poor outcome. Early start of vv-ECMO therapy may lead to better survival in sCOVID-19 patients, although complications during ECMO therapy are associated with a worse prognosis.

The role of ECMO in COVID-19 acute respiratory failure: Defining risk factors for mortality

“…While the ELSO registry reported mortality of approximately 40% for VV ECMO patients in 2020, recent large single-institution studies have shown much greater variability. These reports have ranged from 54% mortality in France18, 50% in Germany22, 22 46% in Italy26, 26 74% in Poland27, 27 and 60% at our center. Differences in patient characteristics during various pandemic periods may explain the heterogeneity of published ECMO-associated outcomes.…”

“…A recent German study of COVID-19 ECMO patients found that renal failure was much more common among non-survivors compared to survivors at 73% versus 33% (p < 0.001). 22 In addition, data from France also found that patients with a lower renal component of the Sequential Organ Failure Assessment (SOFA) score pre-ECMO had a lower risk of mortality.18 Although dialysis can easily be provided to patients while on ECMO, pre-cannulation renal failure may signify greater systemic disease severity and affect prognosis. There is insufficient evidence to include renal failure as a contraindication to ECMO, but like older age, it should be considered in the presence of other adverse prognostic factors, especially if resources are limited.…”

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

“…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]…”

“…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,…”

“…Of the fifty-four included articles, five studies had an NOS score of five [51,63,65,68,69], and twenty-three had a score of six [20,[24][25][26][27]32,35,38,40,[43][44][45][46][47][48]50,52,64,66,67,[70][71][72]. Effect sizes and follow-up times were not reported, raising concerns about selection and outcome bias.…”