In-Hospital and 6-Month Outcomes of COVID-19 Patients Supported with Extracorporeal Membrane Oxygenation: The EuroECMO-COVID Multicenter Prospective Observational Study

Lorusso, Roberto; Piero, Maria Elena De; Mariani, Silvia; Mauro, Michele Di; Coco, Valeria Lo; Folliguet, Thierry; Taccone, Fabio Silvio; Camporota, Luigi; Horst, Iwan C. C. van der; Bussel, Bas C.T. van; Schnabel, Ronny M.; Delnoij, Thijs; Swol, Justyna; Wiedemann, Dominik; Belliato, Mirko; Broman, Lars; Vuylsteke, Alain; Bolotin, Gil; Kassif, Yigal; Scandroglio, Anna Mara; Fanelli, Vito; Gaudard, Philippe; Lorini, Luca; Ledot, Stéphane; Barker, Julian M.; Schmiady, Martin; Boeken, Udo; Schibilsky, David; Maier, Sven; Kersten, Alexander; Meyns, Bart; Pozzi, Matteo; Kowalewski, Mariusz; Pedersen, Finn Møller; Schellongowski, Peter; Pinto, Luis Fernando; Silva, Pedro Eduardo; Kornilov, Igor; Kirali, Mehmet K.; Blandino, A.; Vercaemst, Leen; Finney, Simon J.; Roeleveld, Peter P.; Nardo, Matteo Di; Hennig, Felix; Antonini, Velia M.; Davidson, Mark; Jones, Tim; Barrett, Nicholas; Riera, Jordi; Mueller, Thomas; Bělohlávek, Jan

doi:10.2139/ssrn.4118562

Cited by 8 publications

(11 citation statements)

References 19 publications

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“…Categories delineating race or ethnicity varied markedly. Overall, 54 studies (58%) found no statistical association between race and/or ethnicity and outcome (37–76), while 36 (39%) observed adverse outcomes in populations from underrepresented/diverse racial or ethnic backgrounds (Black/African American, Asian, Hispanic, or “other”/“non-Caucasian”/“non-White”). Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses.…”

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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“…10 On one hand, this is related to the critical condition of these patients, and on the other hand, this is related to the high complication rate of ECMO. [10][11][12] Massive airway hemorrhage is one of the potentially fatal complications of ECMO, and the use of anticoagulants further increases the risk thereof. Once a massive airway hemorrhage occurs in patients, it is often difficult to control with conventional treatment methods.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, ECMO has progressed in technology and management; however, the mortality rate of patients treated with ECMO remains high. 10 On one hand, this is related to the critical condition of these patients, and on the other hand, this is related to the high complication rate of ECMO. [10][11][12] Massive airway hemorrhage is one of the potentially fatal complications of ECMO, and the use of anticoagulants further increases the risk thereof.…”

Section: Discussionmentioning

confidence: 99%

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Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

Zhou

Shi

Guo

2023

Health Science Reports

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Background and Aims: Extracorporeal membrane oxygenation (ECMO) is an important means of treating patients with respiratory failure. Massive airway hemorrhage is a rare complication of ECMO, with high mortality. The aim of this study was to provide a reference for improving the success rate of treatment of this complication by analyzing and summarizing patient clinical data.Methods: We searched PubMed, Medline, and EMBASE databases for case reports of massive airway bleeding associated with ECMO from January 2000 to January 2022 and included one case treated at our facility. All patients were disconnected from the ventilator, and the endotracheal tube was clamped during treatment, resulting in complete airway packing for hemostasis. The clinical data of these patients were analyzed.Results: Through searching and further screening, two works of literature reported four cases that met our inclusion criteria. Including our patient's case, five patients were included in this study (four adults and one neonate). The longest ECMO treatment time before bleeding was 14 days, and the shortest was 20 min. In all patients, conservative treatment was ineffective after a major airway hemorrhage.They were disconnected from the ventilator and the tracheal tube was clamped for 13-72 h. The four adult patients underwent bronchial artery embolization in the interventional radiology suite. All patients' bleeding stopped after treatment; they were successfully weaned off ECMO and discharged. Conclusions: Treatment measures to disconnect the ventilator and clamp the endotracheal tube with full support from ECMO are feasible for massive airway bleeding associated with ECMO. Early bronchial arteriography and embolization can prevent rebleeding.

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“…Follow-up data on patients supported on venovenous ECMO for COVID-19 is lacking (40), with data limited to working status and symptoms evaluated by questionnaire (16). Here, we present a well characterized, unique cohort of patients who had lung function and QOL measured at follow-up.…”

mentioning

confidence: 99%

A Comparison of Long-Term Outcomes in Patients Managed With Venovenous Extracorporeal Membrane Oxygenation in the First and Second Waves of the COVID-19 Pandemic in the United Kingdom

Garfield

Bianchi

Arachchillage

et al. 2023

Critical Care Medicine

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OBJECTIVES: Early studies of venovenous extracorporeal membrane oxygenation (ECMO) in COVID-19 have revealed similar outcomes to historical cohorts. Changes in the disease and treatments have led to differences in the patients supported on venovenous ECMO in the first and second waves. We aimed to compare these two groups in both the acute and follow-up phase. DESIGN: Retrospective single-center cohort study comparing mortality at censoring date (November 30, 2021) and decannulation, patient characteristics, complications and lung function and quality of life (QOL—by European Quality of Life 5 Dimensions 3 Level Version) at first follow-up in patients supported on venovenous ECMO between wave 1 and wave 2 of the COVID-19 pandemic. SETTING: Critical care department of a severe acute respiratory failure service. PATIENTS: Patients supported on ECMO for COVID-19 between wave 1 (March 17, 2020, to August 31, 2020) and wave 2 (January 9, 2020, to May 25, 2021). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred twenty-three patients were included in our analysis. Survival at censoring date (χ2, 6.35; p = 0.012) and decannulation (90.4% vs 70.0%; p < 0.001) was significantly lower in the second wave, while duration of ECMO run was longer (12.0 d [18.0–30.0 d] vs 29.5 d [15.5–58.3 d]; p = 0.005). Wave 2 patients had longer application of noninvasive ventilation (NIV) prior to ECMO and a higher frequency of barotrauma. Patient age and NIV use were independently associated with increased mortality (odds ratio 1.07 [1.01–1.14]; p = 0.025 and 3.37 [1.12–12.60]; p = 0.043, respectively). QOL and lung function apart from transfer coefficient of carbon monoxide corrected for hemoglobin was similar at follow-up across the waves. CONCLUSIONS: Most patients with COVID-19 supported on ECMO in both waves survived in the short and longer term. At follow-up patients had similar lung function and QOL across the two waves. This suggests that ECMO has an ongoing role in the management of a carefully selected group of patients with COVID-19.

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In-Hospital and 6-Month Outcomes of COVID-19 Patients Supported with Extracorporeal Membrane Oxygenation: The EuroECMO-COVID Multicenter Prospective Observational Study

Cited by 8 publications

References 19 publications

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Management of massive airway hemorrhage associated with extracorporeal membrane oxygenation: A retrospective case series study

A Comparison of Long-Term Outcomes in Patients Managed With Venovenous Extracorporeal Membrane Oxygenation in the First and Second Waves of the COVID-19 Pandemic in the United Kingdom

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