Six-Month Survival After Extracorporeal Membrane Oxygenation for Severe COVID-19

Biancari, Fausto; Mariscalco, Giovanni; Dalén, Magnus; Settembre, Nicla; Welp, Henryk; Perrotti, Andréa; Wiebe, Karsten; E, Leo; Loforte, Antonio; Chocron, Sidney; Pacini, Davide; Juvonen, Tatu; Broman, Lars; Perna, Dario Di; Yusuff, Hakeem; Harvey, Chris J.; Mongardon, Nicolas; Maureira, Juan Pablo; Lévy, Bruno; Falk, Lars; Ruggieri, Vito Giovanni; Zipfel, S.; Folliguet, Thierry; Fiore, Antonio

doi:10.1053/j.jvca.2021.01.027

Cited by 57 publications

(81 citation statements)

References 23 publications

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“…In case of severely ill COVID-19 patients, it has been found among 167 COVID-19 patients admitted to an intensive care unit (ICU) that older age and thrombocytopenia, among others, were significant risk factors for mortality at 28, 90 and 180 days [ 11 ]. Furthermore, in a multicentre-study from five European countries of hospitalized COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) showed that advanced age and low pH before ECMO were also associated with an increased risk of mortality within 6 months, with an overall rate of 53% (70/132) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

Günster¹,

Busse

Spoden³

et al. 2021

PLoS ONE

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Background COVID-19 frequently necessitates in-patient treatment and in-patient mortality is high. Less is known about the long-term outcomes in terms of mortality and readmissions following in-patient treatment. Aim The aim of this paper is to provide a detailed account of hospitalized COVID-19 patients up to 180 days after their initial hospital admission. Methods An observational study with claims data from the German Local Health Care Funds of adult patients hospitalized in Germany between February 1 and April 30, 2020, with PCR-confirmed COVID-19 and a related principal diagnosis, for whom 6-month all-cause mortality and readmission rates for 180 days after admission or until death were available. A multivariable logistic regression model identified independent risk factors for 180-day all-cause mortality in this cohort. Results Of the 8,679 patients with a median age of 72 years, 2,161 (24.9%) died during the index hospitalization. The 30-day all-cause mortality rate was 23.9% (2,073/8,679), the 90-day rate was 27.9% (2,425/8,679), and the 180-day rate, 29.6% (2,566/8,679). The latter was 52.3% (1,472/2,817) for patients aged ≥80 years 23.6% (1,621/6,865) if not ventilated during index hospitalization, but 53.0% in case of those ventilated invasively (853/1,608). Risk factors for the 180-day all-cause mortality included coagulopathy, BMI ≥ 40, and age, while the female sex was a protective factor beyond a fewer prevalence of comorbidities. Of the 6,235 patients discharged alive, 1,668 were readmitted a total of 2,551 times within 180 days, resulting in an overall readmission rate of 26.8%. Conclusions The 180-day follow-up data of hospitalized COVID-19 patients in a nationwide cohort representing almost one-third of the German population show significant long-term, all-cause mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profoundly better and long-lasting clinical outcome compared to men.

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Section: Introductionmentioning

confidence: 99%

6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

Günster¹,

Busse

Spoden³

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

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“…Our results suggest that QOL might worsen due to the development of CRDs after ECMO therapy, worsening long-term survival. We believe that our results are important because the number of ECMO survivors is bound to increase in the future due to the COVID-19 pandemic [ 22 ], and the QOL in ECMO survivors can be an important public health issue.…”

Section: Discussionmentioning

confidence: 99%

Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

Cho

Lee

et al. 2021

Respir Res

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Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.

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“…Further, the oxygenation index was significantly lower in the ECMO group on admission (110 (IQR 90-161) vs. 178 (IQR 121-232), p = 0.009). Imaging on hospital admission showed a significantly higher severity score (21)(22) vs. 14 (IQR 10-19), p < 0.001) and significantly higher lung volume involvement (66% (IQR 49-72) vs. 30% (IQR 17-53), p < 0.001, Figure 3B) in the AI based CT assessment. Patients in the ECMO therapy group exhibited a significantly longer time interval from admission to the time point of maximum SOFA score (13 days (IQR 2-15) vs. 2 days (IQR 1-8) in the standard ICU therapy group, p = 0.012).…”

Section: Differences Between the Ecmo Group And Icu Standard Therapy Groupmentioning

confidence: 97%

“…In severe cases of COVID-19 with refractory hypoxemia the use of ECMO as a rescue therapy has been advocated [16][17][18]. Published ECMO mortality rates have ranged widely from around 40 to as high as 90% or above, whereas increasing evidence suggests that COVID-19 ECMO mortality might be similar to known ARDS ECMO mortality rates of around 40-60% and might not be significantly different to overall COVID-19 ICU mortality [2,8,12,[17][18][19][20][21][22][23]. Because ECMO therapy might reduce mortality and outcome is likely to improve when therapy is applied early in severe ARDS, early risk stratification and patient allocation is crucial [17,[24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission

et al. 2021

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(1) Background: Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICUs) remains the last treatment option for Coronavirus disease 2019 (COVID-19) patients with severely affected lungs but is highly resource demanding. Early risk stratification for the need of ECMO therapy upon admission to the hospital using artificial intelligence (AI)-based computed tomography (CT) assessment and clinical scores is beneficial for patient assessment and resource management; (2) Methods: Retrospective single-center study with 95 confirmed COVID-19 patients admitted to the participating ICUs. Patients requiring ECMO therapy (n = 14) during ICU stay versus patients without ECMO treatment (n = 81) were evaluated for discriminative clinical prediction parameters and AI-based CT imaging features and their diagnostic potential to predict ECMO therapy. Reported patient data include clinical scores, AI-based CT findings and patient outcomes; (3) Results: Patients subsequently allocated to ECMO therapy had significantly higher sequential organ failure (SOFA) scores (p < 0.001) and significantly lower oxygenation indices on admission (p = 0.009) than patients with standard ICU therapy. The median time from hospital admission to ECMO placement was 1.4 days (IQR 0.2–4.0). The percentage of lung involvement on AI-based CT assessment on admission to the hospital was significantly higher in ECMO patients (p < 0.001). In binary logistic regression analyses for ECMO prediction including age, sex, body mass index (BMI), SOFA score on admission, lactate on admission and percentage of lung involvement on admission CTs, only SOFA score (OR 1.32, 95% CI 1.08–1.62) and lung involvement (OR 1.06, 95% CI 1.01–1.11) were significantly associated with subsequent ECMO allocation. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.83 (95% CI 0.73–0.94) for lung involvement on admission CT and 0.82 (95% CI 0.72–0.91) for SOFA scores on ICU admission. A combined parameter of SOFA on ICU admission and lung involvement on admission CT yielded an AUC of 0.91 (0.84–0.97) with a sensitivity of 0.93 and a specificity of 0.84 for ECMO prediction; (4) Conclusions: AI-based assessment of lung involvement on CT scans on admission to the hospital and SOFA scoring, especially if combined, can be used as risk stratification tools for subsequent requirement for ECMO therapy in patients with severe COVID-19 disease to improve resource management in ICU settings.

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Six-Month Survival After Extracorporeal Membrane Oxygenation for Severe COVID-19

Cited by 57 publications

References 23 publications

6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission

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