Extracorporeal membrane oxygenation during the first three waves of the coronavirus disease 2019 pandemic: A retrospective single‐center registry study

Abstract

Background Despite increasing knowledge about the optimal treatment for patients with severe COVID‐19, data from different cohorts suggested that survival of patients treated with ECMO seemed to decline over the course of the pandemic. Methods In this non‐interventional retrospective single‐center registry study we analyzed all consecutive patients tested positive for SARS‐CoV‐2 infection and supported with VV ECMO in our center during the first three waves of the pandemic. From March 2020 through June 2021, 59 patients have been included. Results Overall 90‐day survival was 32%. Besides changes in drug treatment for COVID‐19 and a lower PaO 2 /FiO 2 ratio before ECMO initiation during the third wave, all other patient baseline characteristics were similar during the three waves. Survival rate was highest during the first wave and lowest during the third wave, yet this difference was not statistically significant. Conclusions VV ECMO has shown to be a feasible and safe support option for patients with severe respiratory failure due to COVID‐19. The results from this single‐center study confirm findings from other cohorts showing declining survival rates of patients treated with VV ECMO during the COVID‐19 pandemic, however, the specific reasons for this finding remain unclear.

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

“…Of these, 22 were excluded due to their focus on veno-arterial ECMO (V-A ECMO) or extracorporeal cardiopulmonary resuscitation (ECPR) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Fourteen studies were excluded for lack or scarcity of data on CytoSorb© use [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], four because of the lack of specific data for the ECMO subgroup [ 67 , 68 , 69 , 70 ], four because CytoSorb© was not used concomitantly with ECMO therapy [ 71 , 72 , 73 , 74 ], two because outcomes of interest for the simultaneous use of CytoSorb© and ECMO were not reported [ 75 , 76 ], and one because it focused on a different device [ 77 ]. One study was excluded because it only reported preliminary findings from other articles [ 78 ].…”

Extracorporeal membrane oxygenation during the coronavirus disease 2019 pandemic: Continued observations from a retrospective single‐center registry

“…Data for waves 1–3 was reported previously. 4 During the fourth wave, in 10/29 patients (34%) the delta variant was detected, and only in one patient (3%) the omicron variant. For 18/29 patients (62%), no sequencing data was available.…”

“…The data come from a non‐interventional retrospective single‐center registry, as described previously. 4 We included all COVID‐19 patients supported with V‐V ECMO from the beginning of the COVID‐19 pandemic in our center in March 2020 until May 15, 2022. Indication for V‐V ECMO, standard treatment procedures and criteria for discontinuation of ECMO in our center followed established criteria and were applied unchanged throughout the COVID‐19 pandemic.…”

“…A detailed analysis of the patients treated during the first three waves was published recently. 4 Comparing the patients treated during the first three waves with those treated during the fourth wave, the latter were younger (median age (IQR) wave 1–3: 59 (53–63) years; wave 4: 48 (42–56) years; p < 0.001), and they were treated more frequently with tocilizumab (wave 1–3: 9/59 patients (15%), wave 4: 19/29 patients (66%); p < 0.001) and methylprednisolone (wave 1–3: 46/59 patients (78%), wave 4: 29/29 patients (100%); p = 0.004; Table 1 ). Blood purification was used only during the first and the second wave, and then its use was stopped due to the alarm signals found in the CYCOV trial.…”

Acute respiratory distress syndrome following coronary artery bypass grafting successfully treated with venovenous extracorporeal membrane oxygenation

“…Therefore, the PCR testing was repeated twice, and the results were negative. Also, it should be emphasized that ARDS caused by infection with this virus has some unique features, but much of the experience with severe respiratory failure in SARS-CoV-2 patients is not different from other forms of ARDS, and it is one of the indications for the VV-ECMO use [16]. Recent studies have shown that in patients infected with the SARS-CoV-2 and treated with ECMO the mortality in the first 60 days was about 31%, and a very similar result was obtained in the EOLIA study (35% in 60 days) [12].…”