Extracorporeal membrane oxygenation in coronavirus disease 2019

Abstract

BACKGROUND In the context of the coronavirus disease 2019 (COVID-19) pandemic, many retrospective singlecentre or specialised centre reports have shown promising mortality rates with the use of extracorporeal membrane oxygenation (ECMO) therapy. However, the mortality rate of an entire country throughout the COVID-19 pandemic remains unknown.OBJECTIVES The primary objective is to determine the hospital mortality in COVID-19 patients receiving venovenous ECMO (VV-ECMO) and veno-arterial ECMO (VA-ECMO) therapy. Secondary objectives are the chronological development of mortality during the pandemic, the analysis of comorbidities, age and complications. DESIGN Cohort study.SETTING Inpatient data from January 2020 to September 2021 of all hospitals in Germany were analysed.PARTICIPANTS All COVID-19-positive patients who received ECMO therapy were analysed according to the appropriate international statistical classification of diseases and related health problem codes (ICDs) and process key codes (OPSs).MAIN OUTCOME MEASURES The primary outcome was the hospital mortality. RESULTSIn total, 4279 COVID-19-positive patients who received ECMO therapy were analysed. Among 404 patients treated with VA-ECMO and 3875 treated with VV-ECMO, the hospital mortality was high: 72% (n ¼ 291) for VA-ECMO and 65.9% (n ¼ 2552) for VV-ECMO. A total of 43.2% (n ¼ 1848) of all patients were older than 60 years with a hospital mortality rate of 72.7% (n ¼ 172) for VA-ECMO and 77.6% (n ¼ 1301) for VV-ECMO. CPR was performed in 44.1% (n ¼ 178) of patients with VA-ECMO and 16.4% (n ¼ 637) of patients with VV-ECMO. The mortality rates widely varied from 48.1 to 84.4% in individual months and worsened from March 2020 (59.2%) to September 2021 (78.4%).CONCLUSION In Germany, a large proportion of elderly patients with COVID-19 were treated with ECMO, with an unacceptably high hospital mortality. Considering these data, the unconditional use of ECMO therapy in COVID-19 must be carefully considered and advanced age should be considered as a relative contraindication.

Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany

“…In this retrospective observational cohort study, we found that patients admitted to the ICU and treated with IMV due to severe COVID-19 infection—independent of ECMO use—had a high mortality rate. This observation is in accordance with prior published German registry data and confirms the higher mortality of German patients with and without ECMO support in comparison to many other European countries 15 , 16 , 23 . As reported in a large cohort study, advanced age is a strong factor associated with COVID-19 related death 24 .…”

Outcome of Emergency Pulmonary Lobectomy under ECMO Support in Patients with COVID-19

“…In the meantime, single-center experience as well as large national or even supranational register studies have been reported. [16][17][18][19][20][21] Recently published data clearly substantiated the use of ECMO for COVID-19-induced ARDS. 4,22 In parallel with the increased utilization of ECMO during the pandemic, it was to be expected that thoracic surgeons would sooner or later be confronted with the task to provide surgery for COVID-19 patients while on ECMO.…”

“…17 The ECMOVIBER study, 20 which included 338 COVID-19 patients on ECMO at 24 centers in Spain and Portugal, indicated a mortality rate of 49% and a national analysis comprising all hospitals in Germany revealed a mortality rate of 65.9% (2,552 of 3,875) in case of vv-ECMO. 21 Although all participants of these studies received ECMO therapy for COVID-19, none of them underwent major thoracic surgery, let alone anatomical lung resection while on ECMO. Therefore, we feel that our results are well in line with the currently available experience.…”

Venovenous extracorporeal membrane oxygenation for severe COVID-19 pneumonitis: case series from a Hungarian tertiary centre

“…Another contributor could be that the use of ECMO in Germany is not centrally regulated [11]. In Poland ICU mortality rate was high as well, 74.1% for patients requiring ECMO support [12].…”