Risk Factors of Mortality for Patients Receiving Venovenous Extracorporeal Membrane Oxygenation for COVID-19 Acute Respiratory Distress Syndrome

Bergman, Zachary; Wothe, Jillian K.; Alwan, Fatima; Lofrano, Arianna E; Tointon, Kelly M.; Doucette, Melissa; Saavedra-Romero, Ramiro; Prekker, Matthew E.; Lusczek, Elizabeth R.; Beilman, Greg; Brunsvold, Melissa E.

doi:10.1089/sur.2021.114

Cited by 18 publications

(32 citation statements)

References 16 publications

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“…Venovenous extracorporeal membrane oxygenation (V-V ECMO) has been used as treatment for acute respiratory distress syndrome (ARDS) secondary to COVID-19 in select cases that are refractory to conventional treatment. We have previously reported our experience with a survival rate of 65% in patients treated with V-V ECMO for ARDS due to COVID-19, which is in line with other studies ( 1 ). Since publishing this work, new variants have emerged, and therapeutic regimens have been established, both of which may affect outcomes in this population.…”

supporting

confidence: 91%

“…Mortality on V-V ECMO due to COVID-19–associated ARDS significantly increased after October 2020. There were 54 patients who received ECMO support after October 2020, of which 22 (41%) survived until 60-day follow-up compared with 29 (63%) in cohort 1 ( p = 0.026) ( 1 ). The odds ratio of 60-day survival was 2.73 (CI, 1.21–6.15) in cohort 1 compared with cohort 2.…”

Section: Resultsmentioning

confidence: 99%

“…We anecdotally observed increasing short-term mortality among COVID-19 patients selected for V-V ECMO as the pandemic progressed. Therefore, for this analysis, we identified two cohorts of patients who received V-V ECMO in Minnesota: cohort 1 ( n = 46) who received extracorporeal support from March 2020 to October 2020, corresponding to the first surge of COVID-19 cases in our region (and whose outcomes have been previously reported [ 1 ]), and cohort 2 ( n = 54) who received ECMO from November 2020 to May 2021, corresponding to the second surge. Descriptive statistics were used to compare patient characteristics and key outcomes between the two cohorts; the outcome of interest was the difference in 60-day survival between cohorts 1 and 2, evaluated using logistic regression adjusting for the differences between groups and chi-square tests with p < 0.05 representing statistical significance.…”

Section: Methodsmentioning

confidence: 99%

“…The institutional review board approved this study with a waiver of informed consent (University of Minnesota Internal Review Board Study 00010409: V-V ECMO in COVID). Our methodology has been published previously by Bergman et al ( 1 , 2 ) and was not modified for this study.…”

Section: Methodsmentioning

confidence: 99%

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Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

Braaten

Bergman

Wothe

et al. 2022

Critical Care Explorations

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OBJECTIVES:Determine the factors associated with mortality in venovenous extracorporeal membrane oxygenation (V-V ECMO) patients with COVID-19 infection and provide an updated report of clinical outcomes for patients treated with V-V ECMO for COVID-19 in Minnesota. DESIGN:Multicenter prospective observational study. SETTING:The four adult Extracorporeal Life Support Organization-certified Centers of Excellence in Minnesota. PATIENTS:A total of 100 patients treated with V-V ECMO for COVID-19-associated acute respiratory distress syndrome (ARDS) from March 2020 to May 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS:The primary outcome was 60-day survival for patients treated with V-V ECMO for COVID-19. Outcomes of patients treated from November 2020 to May 2021(cohort 2) were compared with data from a previous cohort of patients, collected from March 2020 to October 2020 (cohort 1). The data from both cohorts were merged into a single dataset (Combined Cohort). Survival on V-V ECMO due to COVID-19-associated ARDS significantly decreased after October 2020 (63% vs 41%; p = 0.026). The median interval from hospital admission to V-V ECMO cannulation was significantly associated with 60-day mortality (10 d [6-14 d] in nonsurvivors vs 7 d [4-9 d] in survivors; p = 0.001) in the Combined Cohort and was also significantly longer in cohort 2 than cohort 1 (10 d [7-14 d] vs 6 d [4-10 d]; p < 0.001). In the Combined Cohort, the 60-day survival for patients who did not receive steroids was 86% (n = 12) versus 45% (n = 39) for patients who received at least one dose of steroids (p = 0.005). CONCLUSIONS:There was a significant increase in mortality for patients treated with V-V ECMO for COVID-19-associated ARDS in cohort 2 compared with cohort 1. Further research is required to determine the cause of the worsening trend in mortality.

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supporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

Braaten

Bergman

Wothe

et al. 2022

Critical Care Explorations

Self Cite

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“…1 , Additional file 1 : Table S4) [ 3 , 5 , 16 – 65 ]. All studies were retrospective and observational in nature; 22 studies were conducted by studies centres from Europe [ 5 , 17 , 19 , 23 , 27 , 29 , 31 – 34 , 36 , 39 , 42 , 43 , 45 , 46 , 50 , 55 , 56 , 60 , 63 , 65 ], 17 from North America [ 16 , 18 , 20 – 22 , 24 , 25 , 37 , 40 , 47 , 48 , 52 – 54 , 57 , 58 , 61 ], 6 from the Asia–Pacific [ 26 , 28 , 35 , 38 , 41 , 44 ], 2 from South-West Asia and Africa,[ 51 , 62 ] 2 from Latin America [ 30 , 64 ], and 3 were studies conducted by centres from multiple ELSO regions [ 3 , 49 , 59 ], of which 2 were based on registry data [ 3 , 49 ]. The pooled age was 52.5 years (95% CI 50.7 to 54.3), and the majority of patients were male (75.0%, 95% CI 72.4% to 77.4%) and obese (BMI: 31.0, 95% CI 30.2 to 31.8).…”

Section: Resultsmentioning

confidence: 99%

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

et al. 2022

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Background Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes. Methods We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology. Results Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8–52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run. Conclusions The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation.

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Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

Tran¹,

Fernando²,

Rochwerg³

et al. 2023

The Lancet Respiratory Medicine

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Risk Factors of Mortality for Patients Receiving Venovenous Extracorporeal Membrane Oxygenation for COVID-19 Acute Respiratory Distress Syndrome

Cited by 18 publications

References 16 publications

Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis

Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

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