Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris

Abstract

Background Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020. Methods We included consecutive adults diagnosed with COVID-19 in Paris–Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression. Results Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27–47%) and 48% (37–60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02–5.07). ECMO-related complications did not differ between study periods. Conclusions 90-day mortality of ECMO-supported COVID-19–ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.

Coagulation abnormalities in patients with COVID‐19 on venovenous ECLS increased risk for technical complications and support times but had no impact on survival

“… 33 , 34 While both studies presented a 30d mortality for COVID‐19 patients of 54% and 46%, respectively, the present study showed lower mortality (36%). Current studies in 2021 do specify technical complications with a frequency of 11% to 88%, 5 , 9 , 10 , 11 , 15 , 16 , 26 , 27 , 28 however, there was no correlation with 30d mortality (range, 17% to 73%). The present study clearly showed that the occurrence of technical complications was associated with prolonged length of stay at the ICU and ECLS support times but had no effect on the successful weaning events and 30d‐mortality.…”

“…Despite limited data in the literature, acute clot formation in the blood pumps (PHT) and oxygenators (AOT) in COVID‐19 patients was observed previously. 5 , 8 , 9 , 10 , 11 , 12 , 14 , 15 , 26 , 27 , 28 The focus is less on the cause of the system exchange and more on the necessity of an exchange. While at our ECLS center the incidence of PHT was low and independent of COVID‐19 infection (COVID‐19: 2/69, 3%; non‐COVID: 13/265, 5%), 18 Bemtgen et al 11 documented twice as many PHT in COVID‐19 compared to non‐COVID patients (5/11, 45%; 11/55, 20%).…”

Outcomes by cannulation methods for venovenous extracorporeal membrane oxygenation during COVID‐19: A multicenter retrospective study

“…However, there is a need to further improve outcomes as in‐hospital mortality ranges from 37% to 46%. 4 , 5 , 6 , 7 , 8 , 9 …”

Temporary mechanical circulatory support for COVID‐19 patients: A systematic review of literature

“…A total of 4218 COVID‐19 patients, including 2774 patients (65.8%) supported with ECLS, were comprised in the final analysis (Table 1). Even though the literature search included all publications until October 2021, only four studies reported data referred to patients who received ECLS in 2021 38,39,57,63 . However, only Schmidt et al compared the results of patients receiving ECLS for COVID‐19 during the first wave (before July 1, 2020) and the following waves (from July 1 2020 to January 28 2021).…”

“…The reported median age was 54.3 years (95%CI: 50.7–57.8), with one case series reporting on a population of much younger patients (median: 19; IQR: 17–29) 58 . Most of the studies (Table 1) reported data on body mass index (BMI) referring a median BMI of 29.7 (95% CI: 27.8–30.3), which indicates an overweight or obese status of the population 13,36–38,40,53,54,56–58,60,62,63,65–67,70,71 . The overall survival was 51.9% ( n = 2190).…”