Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation

Abstract

Background Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients. Methods 673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival. Results Most patients were between 50 and 70 years of age. PaO2/FiO2 ratio prior to ECMO was 72 mmHg (IQR: 58–99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41–0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28–1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events. Conclusions Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival. Trial registration Registered in the German Clinical Trials Register (study ID: DRKS00022964, retrospectively registered, September 7th 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964. Graphical abstract

Critically Ill COVID-19 Patients Show Reduced Point of Care-Measured Butyrylcholinesterase Activity—A Prospective, Monocentric Observational Study

“…Comparable mortality rates of up to 71 % in critically ill COVID-19 patients with vvECMO therapy were already observed in a large nation-wide German study with over 10,000 COVID-19 patients [ 30 ]. Accordingly, the analyses of an observational study at 26 German ECMO centers show that in high-volume centers such as ours (defined as specialized ECMO centers with more than 50 vvECMO therapies in 2019) 38% of COVID-19 vvECMO patients survived [ 31 ]. The timing of BChE measurement during SARS-CoV-2 infection in this study is a crucial factor for the interpretation of our data: previous studies evaluated BChE early in acute inflammatory entities, while most COVID-19 patients in our study may have been infected with SARS-CoV-2 for weeks and had already been treated in other intensive care units for several days before being transferred to our department.…”

The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

“…The outcome data for the retrievals do not significantly differ from the in-house cannulations. A comparison to the systems with a proportional reimbursement for care not regulated by medical societies and medical insurance [ 31 ] has been demonstrated particularly during the pandemic of SARS-CoV-2 [ 32 , 33 ].…”

The Prognostic Factors of Bloodstream Infection in Immunosuppressed Elderly Patients: A Retrospective, Single-center, Five-year Cohort Study

“… 32 , 33 The other study showed that BMI <24.9 kg/m 2 was associated with increased mortality risk. 34 This may indicate that BMI had an effect on the prognosis of infectious diseases. In our study, BMI <18.5 kg/m 2 was a protective factor of 90-day death for immunosuppressed elderly people (OR: 0.307, 95%CI: 0.130–0.723, p =0.007).…”