Extracorporeal Membrane Oxygenation in COVID-19-Related Acute Respiratory Distress Syndrome - A EuroELSO International Survey

Mang, Sebastian; Kalenka, Armin; Broman, Lars; Supady, Alexander; Swol, Justyna; Danziger, Guy; Becker, André; Hörsch, Sabrina I.; Mertke, Thilo; Kaiser, Ralf; Bracht, Hendrik; Zotzmann, Viviane; Seiler, Frederik; Bals, Robert; Taccone, Fabio Silvio; Moerer, Onnen; Lorusso, Roberto; Lohlavek, J. B.; Muellenbach, R.M.; Lepper, Philipp M.; Study, Covec

doi:10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2529

Cited by 10 publications

(20 citation statements)

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“…The results were not surprising and quite similar to previous published findings. [1][2][3][4][5][6][7][8][9] The previous Eu-roELSO approved survey was performed in 2 June020 3 and was based on questionnaire consisting of 45 questions and distributed to 4193 physicians with response rate of 9%. At that time, it was highly unlikely that ECLS would be broadly recommended to critical care providers for COVID-19, given its high demands on personnel and resources.…”

Section: Discussionmentioning

confidence: 99%

“…Experience with ECLS for COVID-19 was then still very limited as only two to six patients with COVID-19 had received ECLS in 30% of responding centers, with 85% of all centers having supported a maximum of 15 patients on ECLS in the previous survey. 3 Extracorporeal Life Support Organization Registry and COVID-19 Addendum reported outcomes for 1035 patients with COVID-19 supported on ECLS before May 1st in 2020, with cumulative incidence of in-hospital mortality 90 days after starting ECLS of 37.4%. 10 After 2 years of pandemic, the care of patients with COVID-19 and ECLS criteria for those patients has significantly changed 11 and the use of ECLS has increased.…”

Section: Discussionmentioning

confidence: 99%

“…The findings reflect opinions of a quite large cohort of physicians who used ECLS in COVID-19 patients, but the number of responses was lower compared to the previous EuroELSO survey approved 2 years ago. 3 The survey announcement was broadly open; thus we are not able to provide any response rate because the questionaries were not distributed directly to the centers or individuals. Further, the interpretation of the results regarding countries is not feasible, thus only descriptive characteristics and no generalizability or statistical tests across the countries were performed.…”

Section: Limitationsmentioning

confidence: 99%

“…Thus, ECLS experienced an increasing usage during the COVID-19 pandemic. [1][2][3] To generate a more comprehensive understanding of ECLS usage for adult and pediatric patients a survey was performed which aimed to provide an insight in the use of ECLS for patients with respiratory or cardiac support in COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey

et al. 2023

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Introduction An analysis on the ECLS use for patients with respiratory or cardiac support in COVID-19 based on an international response to EuroELSO survey, aims to generate a more comprehensive understanding of ECLS role during the recent viral pandemic. Methods EuroELSO announced the survey at the 10th annual congress in London, May 2022. The survey covered 26 multiple-choice questions. Results The survey returned 69 questionnaires from 62 centers across 22 European countries and seven centers across five non-European countries. Most of the centers providing ECLS for COVID-19 patients had more than 30 runs for respiratory support since December 2019. In the same period, at least 31 runs in adult COVID-19 patients have been performed in 48 of 69 centers (69.6%). The reported pediatric data from 18 centers is limited to less than the patients per center. Conclusion Majority of the COVID-19 patients received respiratory ECLS support and adult patients dominated. The indications and contraindications are broadly aligned with available guidelines. Most of the centers considered age >65 or biological age as a relative or absolute contraindication for ECLS in COVID-19. ECLS withdrawal criteria in COVID-19 are controversial because the long-term outcomes after ECLS in COVID-19 and the impact of critical illness and the impact of long-COVID are still not known.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey

et al. 2023

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“…31,32 Based on this geographical diversity, it was difficult to understand and assess the actual provision state and regulations throughout Europe either in terms of access or capacity, particularly under pressure during the COVID-19 crisis. 33–35…”

Section: Introductionmentioning

confidence: 99%

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

et al. 2023

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Introduction A cross-sectional survey GENERATE (GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe) initiated on behalf of the European chapter of the Extracorporeal Life Support Organization (EuroELSO), aims to provide a systematic, detailed description of contemporary Extracorporeal Life Support (ECLS) provision in Europe, map the spatial distribution of ECLS centers, and the accessibility of ECLS. Methods Structured data collection forms were used to create a narrative description of ECLS provision in EuroELSO affiliated countries. This consisted of both center-specific data and relevant national infrastructure. Data was provided by a network of local and national representatives. Spatial accessibility analysis was conducted where appropriate geographical data were available. Results 281 centers from 37 countries affiliated to EuroELSO were included in the geospatial analysis and demonstrate heterogeneous patterns of ECLS provision. Accessibility of ECLS services within 1 hour of drive-time is available for 50% of the adult population in 8 of 37 countries (21.6%). This proportion is reached within 2 hours in 21 of 37 countries (56.8%) and within 3 hours in 24 of 37 countries (64.9%). For pediatric centers, accessibility is similar with 9 of 37 countries (24.3%) reached the covering of 50% of the population aged 0–14 within 1 hour and 23 of 37 countries (62.2%) within 2 hours and 3 hours. Conclusions ECLS services are accessible in most of the European countries, but their provision differs across the continent. There is still no solid evidence given regarding the optimal ECLS provision model. The spatial disparity in ECLS provision demonstrated in our analysis requires governments, healthcare professionals and policy makers to consider how to develop existing provision to accommodate the anticipated increase in need for time critical access to this advanced support modality.

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Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19

Immohr

Hettlich

Kindgen‐Milles

et al. 2023

Thorac Cardiovasc Surg

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Background Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation (vv-ECMO) is related with poor outcome, especially in Germany. We aimed to analyze whether changes in vv-ECMO therapy during the pandemic were observed and lead to changes in the outcome of vv-ECMO patients. Methods All patients undergoing vv-ECMO support for COVID-19 between 2020 and 2021 in a single center (n = 75) were retrospectively analyzed. Weaning from vv-ECMO and in-hospital mortality were defined as primary and peri-interventional adverse events as secondary endpoints of the study. Results During the study period, four infective waves were observed in Germany. Patients were assigned correspondingly to four study groups: ECMO implantation between March 2020 and September 2020: first wave (n = 11); October 2020 to February 2021: second wave (n = 23); March 2021 to July 2021: third wave (n = 25); and August 2021 to December 2021: fourth wave (n = 20). Preferred cannulation technique changed within the second wave from femoro-femoral to femoro-jugular access (p < 0.01) and awake ECMO was implemented. Mean ECMO run time increased by more than 300% from 10.9 ± 9.6 (first wave) to 44.9 ± 47.0 days (fourth wave). Weaning of patients was achieved in less than 20% in the first wave but increased to approximately 40% since the second one. Furthermore, we observed a continuous numerically decrease of in-hospital mortality from 81.8 to 57.9% (p = 0.61). Conclusion Preference for femoro-jugular cannulation and awake ECMO combined with preexisting expertise and patient selection are considered to be associated with increased duration of ECMO support and numerically improved ECMO weaning and in-hospital mortality.

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Extracorporeal Membrane Oxygenation in COVID-19-Related Acute Respiratory Distress Syndrome - A EuroELSO International Survey

Cited by 10 publications

References 0 publications

Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey

Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19

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