Role of extracorporeal membrane oxygenation in critically Ill COVID‐19 patients and predictors of mortality

Zayat, Rashad; Kalverkamp, Sebastian; Grottke, Oliver; Durak, Koray; Dreher, Michael; Autschbach, Rüdiger; Marx, Gernot; Spillner, Jan; Kersten, Alex

doi:10.1111/aor.13873

Cited by 31 publications

(61 citation statements)

References 39 publications

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“…Acute myocardial injury in the absence of macroscopic coronary artery disease is suspected to occur in up to 10% of patients especially in the critically ill 15‐18 . In a recent retrospective analysis, Zayat et al found that, among others, increased levels of amino‐terminal pro‐brain natriuretic peptide (NT‐pro‐BNP) predict worse survival in COVID‐19 patients on extracorporeal life support 19 . While 11% of our participants reported that they employed also veno‐arterial ECLS for COVID‐19, only 3% of participants specified that arterial cannulation was required because of acute heart or circulatory failure, in one case caused by fulminant pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

et al. 2021

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Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID‐19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID‐19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID‐19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID‐19 cases, mostly in veno‐venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno‐arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient’s recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID‐19‐induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID‐19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID‐19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID‐19 benefitted from ECLS.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

et al. 2021

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“…Our ECMO administration approaches, including configuration and the applied techniques, were recently published [11]. We used iLA activve ® Pumpe (XENIOS, Heilbronn, Germany) and Cardiohelp HLS Systems Version 7.0 (Maquet Cardiopulmonary GmbH, Rastatt, Germany) ECMO pumps.…”

Section: Ecmo Settingsmentioning

confidence: 99%

Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis

Autschbach

Durak

Grottke

et al. 2021

JCM

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It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients’ characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients’ characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p < 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p < 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.

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“…Our experience as a COVID-19 referral center is consistent with what has been described in the literature. COVID-19 warrants long ECMO runtime and, if necessary, several oxygenator changes or even recannulations, because these factors seem to not be associated with poor survival [ 91 , 184 , 227 , 231 ].…”

Section: Special Considerationmentioning

confidence: 99%

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Harnisch

Moerer

2021

Membranes

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(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute—refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative—advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ −2 points, PRESET score ≥ 6 points, and “do not attempt resuscitation” order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.

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Role of extracorporeal membrane oxygenation in critically Ill COVID‐19 patients and predictors of mortality

Cited by 31 publications

References 39 publications

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

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